产程进展角对妊娠晚期引产结局的预测价值  

The value of angle of progression to predict the outcome of induction of labor in term pregnancy

作　　者：刘沫[1] 王雯雯[1] 呼慧莲 周燕 戴毅敏[1] LIU Mo;WANG Wenwen;HU Huilian;ZHOU Yan;DAI Yimin(Department of Obstetrics and Gynecology,The Affiliated Hospital of Nanjing University Medical School,Jiangsu Nanjing 210000,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,江苏南京210000

出　　处：《中国妇幼健康研究》2023年第11期61-66,共6页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨经会阴超声(TPU)测量产程进展角(AOP)对妊娠晚期引产结局的预测价值。方法选取2020年4月至2021年2月在南京大学医学院附属鼓楼医院住院引产的单胎足月初产妇共106例。引产前,由一位高年资产科医生行宫颈Bishop评分,由另一位高年资产科医生采用TPU测量引产前产妇的AOP。纳入宫颈Bishop评分<6分的产妇,对其均采用欣普贝生引产,根据最终的分娩方式,将其分为阴道分娩组(84例)与剖宫产组(22例),比较两组的AOP,并绘制受试者工作特征(ROC)曲线,寻找预测阴道分娩的AOP最佳临界值。结果引产前,阴道分娩组的AOP明显大于剖宫产组[(100.4±11.6)°vs.(88.3±9.8)°],差异具有统计学意义(t=4.486,P<0.05);阴道分娩组的引产一分娩时间明显短于剖宫产组[1473.5(942.3,2175.8)min vs.1910.0(1599.0,2614.0)min],差异具有统计学意义(Z=-2.750,P<0.05)。当除去非产程因素剖宫产后分析显示,AOP临界值为89°;当引产前AOP>89°时,产妇能经阴道分娩的阴性预测值为96.1%,灵敏度为80.0%,特异度为86.9%。结论AOP可作为初产妇引产成功(阴道分娩)的预测指标,当AOP>89°时,引产后阴道分娩成功率高。Objective To investigate the value of transperineal ultrasound(TPU)measurement of the angle of progression(AOP)in predicting the outcome of induction of labor in late pregnancy.Methods From April 2020 to February 2021,a total of 106 singleton term primigravid women who were hospitalized in the Affiliated Hospital of Nanjing University Medical School were selected.Before induction of labor,one senior obstetrician performed cervical Bishop score,and another senior obstetrician used TPU to measure the AOP of the women before induction of labor.The women with cervical Bishop score<6 were included,and all of them were induced by Dinoprostone,and they were classified into the vaginal delivery group(84 cases)and cesarean section group(22 cases)according to the final mode of delivery,and the AOP of the two groups were compared,and receiver operating characteristic curve(ROC)was plotted to explore the optimal critical value of AOP for predicting vaginal delivery.Result Before induction of labor,the AOP in the vaginal delivery group was significantly greater than that in the cesarean group[(100.4±11.6)°vs.(88.3±9.8)°],and the difference was statistically significant(t=4.486,P<0.05).And the induction-delivery time in the vaginal delivery group was significantly shorter than that in the cesarean group[1473.5(942.3,2175.8)min vs.1910.0(1599.0,2614.0)min],and the diference was statistically significant(Z=-2.750,P<0.05).When non-labor factors were removed for cesarean delivery,the analysis showed a critical AOP value of 89°.When the AOP was>89°prior to induction of labor,the negative predictive value of a woman being able to deliver vaginally was 96.1%,with a sensitivity of 80.0%and a specificity of 86.9%.Conclusion AOP can be used as a predictor of successful IOL(vaginal delivery)in nulliparous women.When AOP is greater than 89°,the rate of successful vaginal delivery after induction of labor is high.

关 键 词：经会阴超声 产程进展角 引产 阴道分娩 产程中剖宫产 

分 类 号：R173[医药卫生—妇幼卫生保健]