胎方位异常阴道分娩第二产程会阴超声测量产程进展参数的临床研究

Clinical study on intrapartum transperineal ultrasound measurement of parameters of the second labor progress in non occipital anterior vaginal delivery management

目的:研究评价会阴超声监测产程进展参数在评估胎方位异常(枕后位或枕横位)阴道分娩管理中的有效性及临床应用。方法:收集2021年6月至2023年6月于南京医科大学附属苏州医院妇产科足月妊娠胎方位异常产妇阴道试产第二产程达2h以上48例。根据分娩方式分为阴道分娩组(35例,A组)和中转剖宫产组(13例,B组)。产程中通过会阴超声测量第二产程不同时间点关键产程进展角(AOP)和中线角(MA)等评估产程进展。比较两组产程AOP及MA等。采用logistic回归分析相关危险因素,采用ROC曲线分析并计算截断值。结果:胎方位异常第二产程宫口开全时,阴道分娩组和中转剖宫产组的AOP平均值分别为(127.5±4.5)°、(107.5±6.6)°;宫口开全1h,AOP平均值分别为(135.3±3.9)°、(114.0±7.8)°;宫口开全2h时,AOP平均值分别为(157.7±5.6)°、(125.3±5.3)°。胎方位异常在第二产程宫口开全时,阴道分娩组和中转剖宫产组的MA平均值为(112.7±18.7)°、(137.2±19.5)°;宫口开全1h,MA平均值分别为(73.9±18.0)°、(128.0±18.9)°;宫口开全2h,MA平均值分别为(28.1±8.1)°、(118.2±16.4)°。两组三个时间点AOP及MA比较,差异均有统计学意义(P<0.05)。Logistic回归分析显示,胎儿体重是影响分娩结局的最大危险因素。ROC曲线提示AOP诊断价值优于MA。根据ROC曲线计算出0、1、2h AOP的截断值分别为118°、129°、142°,0、1、2h MA的截断值分别为94°、74°、45°。结论:通过会阴超声测量产程进展参数AOP及中线角MA,可准确有效评估胎方位异常阴道分娩产程进展,减少产妇阴道指检痛苦及感染风险,及时干预产程,避免母婴分娩严重并发症发生。

Objective:To study and evaluate the effectiveness of intrapartum transperineal ultrasound monitoring the progress of labor parameters in evaluating the management of non-occipital-anterior vaginal delivery and the model of clinical application.Methods:From June 2021 to June 2023,we collected 48 cases of full-term pregnant women with non-occipital-anterior vaginal trial delivery who were admitted to Suzhou Hospital Affiliated to Nanjing Medical University.According to the mode of delivery,there were 35 cases in vaginal delivery group and 13 cases in cesarean section group.During the labor process,intrapartum transperineal ultrasound was used to measure the angle of progression(AOP)and midline angle(MA)at different time points in the second stage of labor to evaluate the progress of labor in Group A and Group B.The statistical differences between the two groups in the angle of labor progress and the midline angle was compared.Logistic regression analysis and receiver operating characteristic analysis were used to calculate the cut-off value of relevant risk factors.Results:The average AOP of vaginal delivery group and cesarean section group were(127.5±4.5)degrees and(107.5±6.6)degrees respectively,when the cervical orifice was fully opened at the initial of the second stage of labor.The average AOP of group A and group B were(135.3±3.9)degrees and(114.0±7.8)degrees respectively after the fully opening of the cervical orifice for 1 hour.The average value of AOP in group A and group B was(157.7±5.6)and(125.3±5.3)degrees at 2 hours after the fully opening of the cervical orifice.In the second stage of labor,the average values of MA in group A and group B were(112.7±18.7)degrees and(137.2±19.5)degrees respectively.The average MA values of group A and group B were(73.9±18.0)degrees and(128.0±18.9)degrees respectively after the fully opening of the cervical orifice for 1 hour.The average values of MA in group A and group B were(28.1±8.1)degrees and(118.2±16.4)degrees respectively after the fully opening of the cervical orifice for 2 hours.There were significant differences in AOP and MA between the two groups at three time points(P<0.05).Logistic regression analysis showed that fetal weight is the largest risk factor affecting delivery outcomes.The receiver operating characteristic suggested that AOP is superior to MA in diagnosis.According to the receiver operating characteristic,the cutoff values of 0h AOP,1h AOP and 2h AOP were 118 degrees,129 degrees and 142 degrees respectively.The cutoff values of 0h MA,1h MA and 2h MA were 94 degrees,74 degrees and 45 degrees respectively.Conclusion:Measuring the parameters of angle of progression and midline angle by intrapartum transperineal ultrasound can accurately and effectively evaluate the progress of non-occipital-anterior vaginal labor,reduce the pain of vaginal digital examination and the risk of infection,timely intervene in the labor process,and avoid the occurrence of serious complications of maternal and infant delivery.