产程进展角、胎头下降距离及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值  

Predictive value of labor progression angle,fetal head descent distance,and their change rate in the outcome of vaginal trial delivery of scarred uterus after cesarean section

作　　者：王忆君 沈丹萍 袁国芳 陈萍 石云 朱峰[1] 裘琳 王嘉宁 WANG Yijun;SHEN Danping;YUAN Guofang;CHEN Ping;SHI Yun;ZHU Feng;QIU Lin;WANG Jianing(Obstetrics Department,Suzhou Ninth Hospital Affiliated to Suzhou University,Suzhou,Jiangsu,215200;Obstetrics Department,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu,215000)

机构地区：[1]苏州大学附属苏州九院产科,江苏苏州215200 [2]南京医科大学附属苏州医院产科,江苏苏州215000

出　　处：《实用临床医药杂志》2024年第20期103-107,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省苏州市“科教兴卫”青年科技项目(KJXW2021078);江苏省苏州市吴江区“科教兴卫”项目(WWK202212)。

摘　　要：目的探讨产程进展角(AOP)、胎头下降距离(HPD)及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值。方法选取剖宫产术后瘢痕子宫再次妊娠经阴道试产的170例孕妇为研究对象,依据试产结局将其分为成功组和失败组。分别采用超声测量第一产程活跃期宫口扩张至4 cm时以及1 h时(宫口开至4 cm后1 h)AOP、HPD,并计算1 h时AOP变化率、HPD变化率。采用受试者工作特征(ROC)曲线分析AOP、HPD及其变化率对剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的预测效能,采用Delong检验比较不同曲线下面积(AUC)的差异。结果170例剖宫产术后瘢痕子宫再次妊娠孕妇中,经阴道试产成功分娩为139例(成功组),试产失败转剖宫产为31例(失败组)。成功组在宫口开至4 cm时的AOP大于失败组,HPD短于失败组,差异均有统计学意义(P<0.05);成功组宫口开至4 cm、1 h时的AOP变化率、HPD变化率均大于失败组,差异有统计学意义(P<0.05)。AOP与HPD预测剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的AUC分别为0.846、0.812,AOP与HPD联合预测的AUC与单独预测的AUC比较,差异无统计学意义(P>0.05)。AOP与HPD的变化率预测剖宫产术后瘢痕子宫再次妊娠经阴道试产结局的AUC分别为0.899、0.852;AOP变化率与HPD变化率联合预测的AUC大于单独预测的AUC,且大于AOP与HPD联合预测的AUC,差异均有统计学意义(P<0.05)。结论第一产程活跃期宫口扩张至4 cm时的AOP、HPD及其变化率对剖宫产术后瘢痕子宫再次妊娠经阴道试产结局具有预测价值。Objective To investigate the predictive value of labor progress angle(AOP),fetal head descent distance(HPD)and their change rates in the outcome of vaginal trial of cesarean scar uterus.Methods A total of 170 pregnant women who underwent vaginal trial production of scar uterus after cesarean section were selected as study subjects,and were divided into successful group and failed group based on the trial production outcomes.Advanced oxidation processes(AOP)and head-perineum distance(HPD)were measured by ultrasound during the active phase of the first stage of labor when the cervix dilated to 4 cm and at 1 hour after the cervix dilated to 4 cm,respectively.The AOP change rate and HPD change rate after 1 hour of progress were calculated.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of AOP,HPD and their change rates in the outcome of vaginal trial production of scar uterus after cesarean section.Delong test was used to compare the differences in area under curves(AUCs).Results Among 170 pregnant women with scarred uterus after cesarean section who were pregnant again,139 cases(success group)were succeed in transvaginal delivery,while 31 cases failed trial delivery,and transferred to cesarean section(failure group).The AOP of the successful group was significantly larger than that of the failed group when the cervix was opened to 4 cm,and the HPD was significantly shorter than that of the failure group(P<0.05).The AOP change rate and the change rate of HPD of the successful group were significantly higher than that of the failed group when the cervix dilated to 4 cm and at 1 hour(P<0.05).The AUC of AOP and HPD in predicting the outcome of vaginal trial delivery of scar uterus after cesarean section were 0.846 and 0.812 respectively,and AUC predicted jointly by AOP and HPD showed no significant differences compared with AUC predicted separately(P>0.05).The AUC of the change rate of AOP and HPD in predicting the outcome of vaginal trial delivery of scarred uterus after cesa

关 键 词：产程进展角 胎头下降距离 瘢痕子宫 阴道试产 剖宫产 

分 类 号：R719.8[医药卫生—妇产科学] R714.4[医药卫生—临床医学] R445.1