胎头自发旋转成功的前瞻性研究  

Prospective study of successful spontaneous rotation of fetal head

作　　者：邵钰帷 沈颖 汪亚丽 方水伟 陈诚 罗琼[2] Shao Yuwei;Shen Ying;Wang Yai;Fang Shuiwei;Chen Cheng;Luo Qiong(Department of Obstetrics and Gynecology,Changxing Maternal and Child Health Hospital,Huzhou 313100,China;Department of Obstetrics and Gynecology,Obstetrics and Gynecology Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]长兴县妇幼保健院妇产科,浙江湖州313100 [2]浙江大学医学院附属妇产科医院妇产科,浙江杭州310006

出　　处：《实用妇科内分泌电子杂志》2023年第29期4-6,共3页Electronic Journal of Practical Gynecological Endocrinology

基　　金：湖州市科学技术局公益性应用研究项目(编号2021GY47)。

摘　　要：目的探讨胎头自发旋转成功的预测因素。方法采用前瞻性研究方法,选择符合纳入排除标准的869名单胎足月初产妇为研究对象。按照胎头是否成功内旋分为内旋成功组419名(48.20%)和内旋失败组104名(12.00%),比较两组妊娠结局及相关因素。结果869名初产妇阴道分娩716名(82.40%),剖宫产153名(17.60%)。两组年龄、身高、分娩方式、产后出血量、新生儿体重、胎儿脊柱前方占比、MLA1、AOP2、MLA2比较,差异均有统计学意义(P<0.05)。依据2个模型绘制ROC曲线,计算曲线下面积显示,在潜伏期预测胎儿自发旋转成功AUC=0.701(95%CI0.634,0.768,P<0.001);活跃期预测胎儿自发旋转成功AUC=0.802(95%CI0.735,0.868,P<0.001)。结论胎儿脊柱位于前方是胎头自发旋转的独立预测因子,第一产程评估胎儿脊柱方位有利于提高阴道分娩成功率。Objective To investigate the predictive factors of successful spontaneous rotation of fetal head.Methods A prospective study method was used to select 869 single term primipara who met the inclusion and exclusion criteria.According to whether the fetal head succeeded in internal rotation,419(48.20%)were divided into successful internal rotation group and 104(12.00%)failed internal rotation group.The pregnancy outcome and related factors were compared between the two groups.Results Among the 869 primipara,716(82.40%)had vaginal delivery and 153(17.60%)had cesarean delivery.There were statistically significant differences in age,height,delivery mode,postpartum blood loss,neonatal weight,fetal spinal front proportion,MLAl,AOP2 and MLA2 between the two groups(P<0.05).ROC curves were drawn according to the two models,and the calculated area under the curves showed that AUC=0.701(95%CI 0.634,0.768,P<0.001)for predicting the success of spontaneous rotation in the incubation period.Active period predicted successful spontaneous fetal rotation AUC=0.802(95%CI 0.735,0.868,P<0.001).Conclusion The anterior position of the fetal spine is an independent predictor of the spontaneous rotation of the fetal head,and the evaluation of the fetal spinal orientation during the first stage of labor is beneficial to improve the success rate of vaginal delivery.

关 键 词：初产妇 胎儿脊柱方位 自发旋转 阴道分娩 

分 类 号：R714.44[医药卫生—妇产科学]