产程进展角对第二产程超过2h初产妇分娩结局的预测价值分析  

Predictive value of the angle of progression in the labor process for delivery outcomes of primiparous women with a second stage of labor exceeding 2 hours

作　　者：汪敏敏 孙素芳 曹芬 柴竞竞 WANG Minmin;SUN Sufang;CAO Fen;CHAI Jingjing(Department of Obstetrics,the First People's Hospital of Fuyang District,Hangzhou 311400,China)

机构地区：[1]杭州市富阳区第一人民医院产科,311400

出　　处：《浙江医学》2025年第6期605-609,614,共6页Zhejiang Medical Journal

基　　金：杭州市农业与社会发展科研引导项目(20220919Y124)。

摘　　要：目的分析超声检测的产程进展角(AOP)对第二产程(SSL)超过2 h初产妇分娩结局的预测价值。方法回顾性选取2021年1月至2024年5月在杭州市富阳区第一人民医院住院分娩的SSL超过2 h的初产妇378例,根据最终分娩方式分为阴道分娩组316例和剖宫产组62例。比较两组初产妇宫口开到3 cm时、SSL开始时、SSL 2 h时的AOP及分娩孕周、新生儿体重等临床资料,采用多因素logistic回归分析SSL超过2 h初产妇剖宫产的危险因素。采用ROC曲线分析不同时间点AOP对SSL超过2 h初产妇分娩结局的预测效能。结果剖宫产组初产妇宫口开到3 cm时、SSL开始时、SSL 2 h时的AOP均小于阴道分娩组(均P<0.05)。两组产妇分娩孕周、新生儿体重比较差异均有统计学意义(均P<0.05)。新生儿体重≥3.445 kg、宫口开3 cm时AOP≤110°、SSL开始时AOP≤123°、SSL 2 h时AOP≤136°均是SSL超过2 h初产妇剖宫产的独立危险因素(均P<0.05)。宫口开3 cm时、SSL开始时、SSL 2 h时的AOP单独应用均能有效预测SSL超过2 h初产妇的剖宫产风险,三者联合应用预测价值优于单独应用,AUC=0.915(95%CI:0.885~0.945,P<0.05),准确度为0.749,灵敏度为1.000,特异度为0.699。结论超声动态检测宫口开3 cm时、SSL开始时、第二产程2 h时的AOP,对于SSL超过2 h初产妇的最终分娩方式有一定影响及早期预测价值,联合应用预测价值优于单独应用。Objective To analyze the predictive value of the angle of progression(AOP)measured by ultrasound on delivery outcomes of primiparous women with a second stage of labor(SSL)exceeding 2 hours.Methods A retrospective study was conducted on 378 primiparous women with SSL exceeding 2 hours who delivered at the First People's Hospital of Fuyang District,Hangzhou,from January 2021 to May 2024.Based on the final delivery mode,the participants were divided into a vaginal delivery group(316 cases)and a cesarean section group(62 cases).The AOP at cervical dilation of 3 cm,at the beginning of SSL,and at 2 hours into SSL,as well as clinical data such as gestational age at delivery and neonatal weight,were compared between the two groups.Multivariate logistic regression analysis was used to identify risk factors for cesarean section in primiparous women with SSL exceeding 2 hours.The predictive value of AOP at different time points for delivery outcomes was evaluated using ROC curve analysis.Results The AOP at cervical dilation of 3 cm,at the beginning of SSL,and at 2 hours into SSL were all smaller in the cesarean section group compared to the vaginal delivery group(all P<0.05).Significant differences were observed in gestational age at delivery and neonatal weight between the two groups(all P<0.05).Neonatal weight≥3.445 kg,AOP≤110°at cervical dilation of 3 cm,AOP≤123°at the beginning of SSL,and AOP≤136°at 2 hours into SSL were identified as independent risk factors for cesarean section of primiparous women with SSL exceeding 2 hours(all P<0.05).The AOP at cervical dilation of 3 cm,at the beginning of SSL,and at 2 hours into SSL,when used individually,effectively predicted the risk of cesarean section in primiparous women with SSL exceeding 2 hours.The combined predictive value of these three AOP measurements was superior to individual use,with an AUC of 0.915(95%CI:0.885-0.945,P<0.05),accuracy of 0.749,sensitivity of 1.000,and specificity of 0.699.Conclusion Dynamic ultrasound measurement of AOP at cervical dilati

关 键 词：初产妇 第二产程 产程进展角 分娩结局 

分 类 号：TP3[自动化与计算机技术—计算机科学与技术]