经会阴二维超声参数评估初产妇分娩方式及产程

Evaluation of Perineal Two-Dimensional Ultrasound Parameters for the Delivery Mode and Process of Primiparous Women

目的探讨经会阴二维超声参数对初产妇分娩方式及产程的评估价值。方法回顾性分析2021年2月至2023年8月在郑州市妇幼保健院经阴道试产的162例初产妇资料,根据分娩结局分为自然分娩组和剖宫产组。比较两组宫口扩张6 cm时的经会阴二维超声参数[产程进展角(AOP)、胎头-会阴距离(HPD)],绘制受试者工作特征(ROC)曲线检验AOP、HPD对初产妇分娩方式的预测价值。以AOP、HPD中位数进行分组,比较不同AOP、HPD的初产妇分娩方式及产程时间的差异,采用Pearson相关性分析,检验AOP、HPD与自然分娩初产妇产程时间的关系。结果162例初产妇中127例为自然分娩,35例为剖宫产。自然分娩组初产妇AOP、HPD大于剖宫产组(P<0.05)。ROC曲线结果显示,AOP、HPD预测初产妇自然分娩的曲线下面积(AUC)均>0.7,有一定预测价值,且以二者联合预测价值最高。162例初产妇AOP、HPD中位数分别为132°、4.1 cm,AOP≥132°、HPD≥4.1 cm组初产妇的自然分娩率分别高于AOP<132°组、HPD<4.1 cm组(P<0.05)。127例自然分娩初产妇的AOP、HPD中位数分别为133°、4.3 cm,AOP≥133°组、HPD≥4.3 cm组自然分娩初产妇的第一产程、第二产程及总产程时间均分别短于AOP<133°组、HPD<4.3 cm组(P<0.05)。经Pearson相关性检验,AOP、HPD与自然分娩初产妇第一产程、第二产程、总产程均呈负相关(r<0,P<0.05)。结论经会阴二维超声参数AOP、HPD可用于指导初产妇分娩方式的合理选择,二者与产程有关,能够为分娩管理提供参考。

Objective To explore the evaluation value of perineal two-dimensional ultrasound parameters on the delivery mode and process of primiparous women.Methods The data of 162 primiparas who underwent vaginal trial delivery in Women and Infants Hospital of Zhengzhou from February 2021 to August 2023 were retrospectively analyzed.According to the maternal data,they were divided into natural delivery group and cesarean section group according to the delivery outcome.The transperineal two-dimensional ultrasound parameters[progress angle of labor(AOP),fetal head-perineum distance(HPD)]were compared between the two groups when the cervix dilated 6 cm,and the receiver operating characteristic(ROC)curve was drawn to test the predictive value of AOP and HPD on the delivery mode of primiparas.The medians of AOP and HPD were grouped to compare the differences in delivery mode and labor time of primiparas with different AOP and HPD.Pearson correlation analysis was used to test the relationship between AOP,HPD and labor time of primiparas with natural delivery.Results According to the data of 162 primiparous women,127 cases underwent natural delivery and 35 cases underwent cesarean section.The AOP and HPD of primiparous women in the natural delivery group were higher than those in the cesarean section group(P<0.05).The ROC curve was drawn,and the area under curve(AUC)of AOP and HPD in predicting natural delivery of primipara was>0.7,which had certain predictive value,and the combined predictive value of the two was the highest.The median AOP and HPD of 162 primiparous women were 132°and 4.1 cm,respectively.The natural delivery rates of primiparous women in the AOP≥132°and HPD≥4.1 cm groups were higher than those in the AOP<132°and HPD<4.1 cm groups(P<0.05).The median AOP and HPD of 127 primiparous women undergoing natural delivery were 133°and 4.3 cm,respectively.The first,second,and total stages of labor in the AOP≥133°and HPD≥4.3 cm groups were shorter than those in the AOP<133°and HPD<4.3 cm groups(P<0.05).According to Pearson correlation test,AOP and HPD were negatively correlated with the first,second,and total stages of labor in natural childbirth primiparous women(r<0,P<0.05).Conclusion Perineal two-dimensional ultrasound parameters AOP and HPD can be used to guide the reasonable selection of delivery methods for primiparous women,which are related to the birth process and can provide reference for delivery management.