三维超声测量AOP和HPD在异常产程中指导分娩策略的临床价值  

Clinical value of three-dimensional ultrasound measurement of AOP and HPD in guiding delivery strategies during abnormal labor processes

作　　者：李璐 谭烨 吴春晓 LI Lu;TAN Ye;WU Chun-xiao(Department of Obstetrics,Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine,Zhuhai Guangdong 519020,China)

机构地区：[1]珠海市中西医结合医院产科,广东珠海519020

出　　处：《临床和实验医学杂志》2024年第3期285-289,共5页Journal of Clinical and Experimental Medicine

基　　金：广东省科技计划项目(技术开发及产业化类别)项目(编号:411255342023);珠海市科技创新局项目(编号:ZH22036201210002PWC)。

摘　　要：目的 探讨三维超声测量胎头进展角(AOP)和胎头下降距离(HPD)在异常产程中指导分娩策略的临床价值。方法 采用前瞻性研究方法,选取2021年8月至2023年2月在珠海市中西医结合医院行阴道试产过程中出现异常的产妇160例作为研究对象,按照随机数字表法将其分为观察组(n=80)和对照组(n=80)。观察组给予三维超声监测指导分娩,对照组给予传统阴道指检指导分娩。观察两组分娩方式、不良母婴结局发生的差异,同时分析观察组阴道分娩和剖宫产产妇宫口扩张4 cm、宫口扩张4 cm后2 h时胎头方向角(HD)、AOP、HPD和中线角度(MLA);采用受试者工作特征(ROC)曲线分析产妇阴道分娩的价值。分析观察组阴道分娩超声参数与分娩时长的相关性。结果 观察组阴道分娩比例为82.50%,明显高于对照组(60.00%),总不良母婴结局发生率为7.50%,明显低于对照组(21.25%),差异均有统计学意义(P<0.05)。观察组阴道分娩产妇宫口扩张4 cm时、宫口扩张4 cm后2 h时AOP分别为(114.45±11.02)°、(126.64±13.32)°,均高于剖宫产产妇[(101.43±9.98)°、(115.29±12.82)°],宫口扩张4 cm后2 h时HPD为(26.76±4.43)mm,低于剖宫产产妇[(30.10±4.13)mm],差异均有统计学意义(P<0.05)。宫口扩张4 cm时AOP预测阴道分娩的ROC曲线下面积为0.819;宫口扩张4 cm后2 h时AOP和HPD预测阴道分娩的ROC曲线下面积分别为0.816和0.728;阴道分娩产妇宫口扩张4 cm时AOP与分娩时长呈负相关(P<0.05),宫口扩张4 cm时HPD与分娩时长呈正相关(P<0.05)。结论 三维超声测量在异常产程中指导分娩有较好的应用价值,具有提高阴道分娩率,减少不良母婴结局发生的优点,同时AOP和HPD参数在预测阴道分娩方面有一定价值,且与分娩时长有关。Objective To explore the clinical value of three-dimensional ultrasound measurement of fetal head angle of progression(AOP) and fetal head-perineum-distance(HPD) in guiding delivery strategies during abnormal labor processes.Methods One hundred and sixty pregnant women who experienced abnormalities during vaginal trial delivery in Zhuhai Integrated Traditional Chinese and Western Medicine Hospita from August 2021 to February 2023 were prospectively selected,the postpartum women were divided into observation group(n=80) and control group(n=80) according to the random number table method.The observation group was given three-dimensional ultrasound monitoring to guide delivery,the control group received traditional vaginal digital examination guidance for delivery.The differences in delivery methods and adverse maternal and infant outcomes between the two groups were observed.The fetal head direction(HD),AOP,HPD,and midline angle(MLA) at the dilation of the cervix 4 cm and 2 h after dilation of the cervix 4 cm were analyzed.The predictive value of vaginal delivery in parturients was analyzed using receiver operating characteristic(ROC) curves.The correlation between ultrasound parameters of vaginal delivery and delivery duration in the observation group was analyzed.Results The proportion of vaginal delivery in the observation group was 82.50%,which was significantly higher than that in the control group(60.00%),the total incidence of adverse maternal and infant outcomes in the observation group was 7.50%,which was significantly lower than that in the control group(21.25%),the differences were statistically significant(P< 0.05).The AOP at the dilation of the cervix 4 cm and 2 h after dilation of the cervix 4 cm in the observation group were(114.45±11.02) ° and(126.64±13.32) °,respectively,which were higher than those of cesarean section women [(101.43±9.98) ° and(115.29±12.82) °],the HPD at 2 h after dilation of the cervix 4 cm was(26.76±4.43) mm,which was lower than that of cesarean section women [(30.10±

关 键 词：三维超声 胎头进展角 胎头下降距离 异常产程 

分 类 号：R714[医药卫生—妇产科学]