产前超声检查预测足月初产妇分娩方式的初步研究  

Preliminary study of prenatal ultrasound in predicting delivery mode of full-term primipara

作　　者：徐净[1] 郑志娟[1] 张奥华[1] 黄泽萍[1] 黄冬梅[1] 张新玲[1] Xu Jing;Zheng Zhijuan;Zhang Aohua;Huang Zeping;Huang Dongmei;Zhang Xinling(Department of Ultrasound,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院超声科,广州510630

出　　处：《中华超声影像学杂志》2021年第10期880-884,共5页Chinese Journal of Ultrasonography

摘　　要：目的探讨产前超声检查预测足月初产妇分娩方式的可行性。方法前瞻性纳入2020年9月至2021年2月于中山大学附属第三医院常规产检的初产妇女,孕周≥37周、单胎、头位、无阴道分娩禁忌证,除常规胎儿超声检查外,同时行经会阴超声检查,测量产程进展角(angle of progression,AOP)、胎头至会阴距离(head-perineum distance,HPD)、耻骨弓角及不同状态下孕妇肛提肌裂孔的前后径、左右径、面积、周长等指标;经阴道超声检查宫颈长度(cervical length,CL)。追踪其分娩方式,并筛选出与自然分娩相关的指标,使用ROC曲线评估相关指标预测自然分娩的效能。结果共142例初产妇纳入本研究,其中自然分娩112例,人工干预分娩30例,自然分娩组与人工干预分娩组之间,年龄、孕周、双顶径、头围、体质指数、新生儿体重比较,差异无统计学意义(均P>0.05)。多因素回归分析显示AOP与自然分娩相关(OR=1.048,P=0.008)。ROC曲线分析显示,以AOP 96.92°为节点时的曲线下面积为0.648,其特异性、阳性预测值分别为83.33%、0.9091。结论足月初产妇产前超声检查预测分娩方式具有可行性,其中AOP与分娩方式相关,可为临床提供更多参考信息。Objective To explore the feasibility of prenatal ultrasound in predicting delivery mode of full-term primipara.Methods The study prospectively enrolled primiparas with gestational age≥37 weeks,singleton,cephalic and no contraindications to vaginal delivery who underwent routine prenatal examination in the Third Affiliated Hospital of Sun Yat-sen University from September 2020 to February 2021.In addition to routine fetal ultrasound examination,the transperineal ultrasound examination was performed to assess the angle of progression(AOP),head perineum distance(HPD),the angle of pubic arch and the anteroposterior diameter,left and right diameter,area and perimeter of levator ani hiatus of pregnant women in different states were measured;Cervical length(CL)was examined by transvaginal ultrasound.The delivery mode was tracked,and the indicators related to natural delivery were screened out.Receiver operating characteristic(ROC)curve was used to evaluate the effectiveness of relevant indicators in predicting natural delivery.Results A total of 142 cases were included in this study,including 112 cases of natural delivery and 30 cases of manual intervention delivery.There were no significant differences in age,gestational weeks,biparietal diameter,head circumference,body mass index(BMI)and neonatal weight between the natural delivery group and the manual intervention delivery group(all P>0.05).Multivariate regression analysis showed that AOP was associated with natural delivery(OR=1.048,P=0.008).ROC curve analysis showed that the area under the curve was 0.648 with AOP 96.92°as the node,and the specificity and positive predictive values were 83.33%and 0.9091 respectively.Conclusions It is feasible to predict the mode of delivery by prenatal ultrasound in full-term primiparas.AOP is related to the mode of delivery,which can provide more reference information for clinical practice.

关 键 词：超声检查 产前 盆底 预测 分娩方式 产程进展角 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]