经会阴三维超声测量产程进展参数在分娩时长预测中的价值研究  

Prediction of time to delivery by intrapartum parameters determined by three- dimensional transperineal ultrasound

作　　者：李佳[1] 尹爱兰[1] 钟梅[1] 罗漫灵[1] 胡海燕[1] 黄晓莉[1] 张敏[2] 裘毓雯[1] 尹倩[1] 陈淑滢[1] 陈茜[1] 李洪葳 

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]南京医科大学第一附属医院妇产科,江苏南京210000

出　　处：《中国实用妇科与产科杂志》2016年第10期979-985,共7页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：广东省省级科技计划项目(2015B020214004);新业务新技术院级课题(2013017)

摘　　要：目的探讨经会阴三维超声测量产程进展参数在分娩时长预测中的价值。方法纳入2015年9-12月在南方医科大学南方医院妇产科足月、单胎、头先露、阴道试产初产妇共151例。分别于宫口扩张4 cm（T1）及T1后1-2 h（T2）应用经会阴三维超声测量产程进展参数：胎头方向角（HD）、脑中线角度（MLA）、胎头下降距离（HPD）、胎头进展角（AOP）。应用卡方检验对T1、T2各产程进展参数分组的自然分娩率进行对比性研究。应用Kaplan-Meier法分析T1、T2产程进展参数对孕妇分娩时长的预测价值。结果 （1）AOP≤110°者（82.4%）与AOP〉110°者（96.0%）,后者较前者自然分娩率更高,差异有统计学意义（P〈0.05）;MLA〉75°者（82.1%）与MLA≤75°者（97.7%）,HPD≤40mm者（85.3%）与HPD〉40 mm者（98.5%）,AOP≤120°者（81.0%）与AOP〉120°者（96.0%）,后者较前者自然分娩率均更高,差异有统计学意义（P〈0.05）。（2）T1时,以90°、75°、30 mm、110°分别作为HD、MLA、HPD、AOP的截断值,HD、HPD、AOP较大者,MLA较小者更快分娩,差异均有统计学意义（P〈0.05）;T2时,以120°、75°、40 mm、120°分别作为HD、MLA、HPD、AOP的截断值,HD、HPD、AOP较大者,MLA较小者更快分娩,差异均有统计学意义（P〈0.05）。结论经会阴三维超声测量产程进展参数对分娩时长有良好的预测价值。Objective To investigate whether intrapartum parameters by three-dimensional transperineal ultrasound are predictive of time to delivery in nulliparous women. Methods This was a prospective observational study at Nanfang Hospital, Guangzhou, China,from September 2015 to December 2015. Totally 151 nulliparous singleton pregnancies with cephalic presentation at term who preferred to have vaginal delivery were included. We measured head direction（HD）,midline angle（MLA）, head progression distance（HPD） and angle of progression（AOP） with three-dimensional transperineal ultrasound when the pregnancies＇ cervix dilated to 4cm（T1） and 1-2 hours later（T2）. Chi-square test was used to compare the rate of spontaneous delivery among different groups of progression parameters（HD,MLA,HPD,AOP）. KaplanMeier survival analysis was used to analyze the relationship between time to delivery and progression parameters.Results （1）The spontaneous delivery rate of Group AOP≤110°（82.4%） was lower than Group AOP110°（96.0%）（P〈0.05）; the spontaneous delivery rate of Group MLA〉75°（82.1%） was lower than Group MLA≤75°（97.7%）; Group HPD≤40mm（85.3%） was lower than Group HPD〉40mm（98.5%）;Group AOP≤120°（81.0%） was lower than Group AOP〉120°（96.0%）, respectively（P〈0.05）.（2）At T1, using 90°,75°,30 mm and 110° as the cut- off level of HD,MLA,HPD and AOP respectively, the women with larger HD,HPD, AOP and smaller MLA are considered to deliversooner（P〈0.05）; at T2,using 120°,75°,40 mm and 120° as the cut-off level of HD,MLA,HPD and AOP respectively, the women with larger HD,HPD, AOP and smaller MLA delivered sooner（P〈0.05）.Conclusion Intrapartum parameters by three-dimensional transperineal ultrasound are predictive of time to delivery in nulliparous women.

关 键 词：SONO VCAD Labor软件 产程监测 产程进展 分娩时长 经会阴三维超声 

分 类 号：R714[医药卫生—妇产科学]