宫颈超声弹性成像联合Bishop评分对宫颈双球囊促宫颈成熟的效果分析  

Clinical outcome analysis of cervical elastography combined with Bishop score for cervical ripening by cervical double ballooning

作　　者：温娇 赵云[2] 汤斐 吕玉霞 李丽[3] WEN Jiao;ZHAO Yun;TANG Fei;LÜYuxia;LI Li(College of Medicine,Wuhan University of Science and Technology,Wuhan 430065,Hubei,China;Dept.of Obstetrics,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,Hubei,China;Dept.of Ultrasound,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,Hubei,China)

机构地区：[1]武汉科技大学医学院,湖北武汉430065 [2]华中科技大学同济医学院附属湖北妇幼保健院产科,湖北武汉430070 [3]华中科技大学同济医学院附属湖北妇幼保健院超声科,湖北武汉430070

出　　处：《武汉大学学报(医学版)》2025年第1期79-85,118,共8页Medical Journal of Wuhan University

基　　金：武汉市科技计划‑应用基础前沿专项(编号:2020020601012215);中国妇幼保健协会资助项目(编号:ZGFY‑B‑201905)。

摘　　要：目的:探讨宫颈超声弹性成像联合传统Bishop评分在4‑h宫颈双球囊(CDB)促宫颈成熟中的应用并对其临床效果进行分析。方法:收集2022年11月—2023年10月于湖北省妇幼保健院光谷院区住院且使用CDB促宫颈成熟的催引产孕妇共448例。根据经阴道宫颈超声弹性成像及Bishop评分决定CDB放置时间,将其分为4‑h CDB组(n=57)和12‑h CDB组(n=391),比较两组孕产妇阴道分娩成功率、CDB置入至分娩时间、CDB置入前后宫颈Bishop评分的变化、第一、二、三产程的变化、产时干预情况、分娩时情况、产褥感染、转ICU率及新生儿结局。结果:4‑h CDB组前次剖宫产患者的阴道分娩率大于对照组(P<0.05),其CDB促宫颈成熟前Bishop评分、宫颈弹性对比指数(4.03 vs 3.68)、宫颈内口应变值(0.39 vs 0.36)、宫颈外口应变值(0.38 vs 0.35)高,硬度比(48.72 vs 52.40)、宫颈长度(2.29 cm vs 2.56 cm)短于对照组(P<0.05);4‑h CDB组球囊置入至分娩时间、取出至临产时间均低于对照组(P<0.05);4‑h CDB组阴道分娩率89.5%,高于对照组(75.7%,P<0.05),其球囊置入至分娩12 h内发生率为49.0%、高于对照组(0.6%,P<0.05);其产后出血量及住院天数低于对照组(P<0.05)。结论:若是宫颈条件较成熟,使用4‑h CDB,可以明显缩短球囊置入至分娩、球囊取出至分娩发动时间,且不增加催引产并发症,安全有效,值得临床应用。经阴道宫颈超声弹性成像技术联合传统Biship评分,可更客观评估催引产前宫颈成熟情况。Objective:To investigate the application of cervical ultrasound elastography combined with traditional Bishop score in evaluating the clinical outcome of the 4‑h cervical double balloon(CDB)for cervical ripening.Methods:A total of 448 pregnant women who were hospitalized in the Guanggu branch of Huibei Maternal and Child Health Care Hospital from November 2022 to October 2023 and were induced with CDB for cervical ripening were collected.The time of CDB placement was determined according to transvaginal cervical ultrasound elastography and Bishop score,and the cases were divided into the 4‑h CDB group(n=57)and the 12‑h CDB group(n=391).The success rate of vaginal delivery,the time from CDB placement to delivery,changes in cervical Bishop score,changes among the first,second,and third stages of labor,interventions at the time of delivery,conditions at delivery,puerperal infections,ICU transfer rate,and neonatal outcomes were recorded and compared.Results:The 4‑h CDB group had a greater rate of vaginal delivery by previous cesarean section than the control group(P<0.05)and had a higher CDB‑promoted pre‑cervical ripening Bishop score.The cervical elastographic indices such as ECI(4.03 vs 3.68),IOS(0.39 vs 0.36),EOS(0.38 vs 0.35),and HR(48.72 vs 52.40),and CL(2.29 cm vs 2.56 cm)were significantly different between the two groups(P<0.05).In the 4‑h CDB group,the time from balloon insertion to delivery and removal to labor were shorter than in the control group(P<0.05),the rate of vaginal delivery was higher(87.7%vs 78.0%,P<0.05),the incidence rate of the 12 h period from balloon insertion to delivery was also higher(49.0%vs 0.6%,P<0.05),and the postpartum hemorrhage and hospitalization stay were less than that in the control group(P<0.05).Con-clusion:If cervical conditions are mature,a 4‑hour CDB can significantly reduce the time from balloon insertion to labor initiation and from balloon removal to labor,without increasing the risks associated with induced labor.This method is safe,effective,and suita

关 键 词：促宫颈成熟 宫颈双球囊 宫颈弹性成像技术 催引产 

分 类 号：R714[医药卫生—妇产科学]