产时超声指标预测胎头吸引产术的难易程度  

Predictive value of intrapartum ultrasound indicators for difficulty assessment in vacuum-assisted delivery

作　　者：张培[1] 张媛[1] 王青青[1] 侯红瑛[1] 韩振艳[1] Zhang Pei;Zhang Yuan;Wang Qingqing;Hou Hongying;Han Zhenyan(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院妇产科,广州510630

出　　处：《中华围产医学杂志》2025年第3期194-202,共9页Chinese Journal of Perinatal Medicine

基　　金：广东省卫生健康适宜技术推广项目(202107012114376473)。

摘　　要：目的探讨产时超声指标对胎头吸引产术难易程度的预测作用。方法本研究为前瞻性队列研究。以2021年2月至2022年12月在中山大学附属第三医院住院分娩,有胎头吸引产手术指征,且在术前10 min内完成产时超声检查的单胎产妇为研究对象。产时超声指标包括胎方位、胎头进展角(angle of progression,AOP)和胎头会阴距离(head-perineum distance,HPD)。根据胎头吸引产术中情况分为吸引产容易组和吸引产困难组(分别简称容易组和困难组)。比较2组产妇在吸引产术前的胎方位、AOP、HPD及分娩结局,探讨产时超声指标与胎头吸引产术难易程度的相关性及其预测价值。采用独立样本t检验、U检验、χ^(2)检验(或Fisher精确概率法)、logistic回归分析和受试者工作特性(receiver operating characteristic,ROC)曲线等方法进行统计和预测价值分析。结果共162例纳入研究,其中容易组120例,困难组42例。162例产妇年龄20~44岁,平均(30.6±3.9)岁;107例(66.0%)为首次妊娠,139例(85.8%)为首次分娩。(1)困难组与容易组的胎头位置分别为2.3(2.0~2.5)cm和2.0(2.0~2.5)cm,差异无统计学意义(P>0.05)。困难组在宫缩间歇期和宫缩期的AOP和ΔAOP分别小于容易组[分别为(138.1±8.8)°与(143.8±7.9)°,t=3.89;(148.7±9.3)°与(157.9±8.9)°,t=5.67,以及(10.6±6.4)°与(14.1±6.3)°,t=3.08;P值均<0.01],而困难组宫缩间歇期和宫缩期的HPD和ΔHPD大于容易组[分别为(3.4±0.5)cm与(3.2±0.4)cm,t=-2.69;(2.8±0.5)cm与(2.4±0.5)cm,t=-4.70;(-0.5±0.4)cm与(-0.8±0.5)cm,t=-2.83;P值均<0.01]。(2)困难组7例因吸引器脱杯2~3次改产钳分娩;容易组均在吸引器牵引1~2次后成功分娩。困难组吸引产术时长长于容易组[7.0(6.0~10.0)min与3.0(2.0~3.0)min,Z=9.65](P值均<0.001)。(3)困难组4例发生了严重的母儿分娩并发症,包括2例肩难产、1例吸引产失败改钳产后发生膀胱阴道瘘,以及1例吸引产失败改钳产后发生Ⅲ度会阴裂伤�ObjectiveTo investigate the predictive role of intrapartum ultrasound indicators on the difficulty of vacuum-assisted delivery.MethodsA prospective cohort study was conducted.The study subjects were singleton pregnant women hospitalized for delivery at the Third Affiliated Hospital of Sun Yat-sen University from February 2021 to December 2022,who had indications for vacuum-assisted delivery,and completed intrapartum ultrasound examination within 10 minutes before the procedure.Intrapartum ultrasound indicators included fetal position,angle of progression(AOP),and head-perineum distance(HPD).Based on the difficulty of vacuum-assisted delivery,the subjects were divided into easy and difficult groups.The fetal position,AOP,and HPD before vacuum-assisted delivery and delivery outcomes were compared between the two groups to explore the correlation and predictive value of intrapartum ultrasound indicators on the difficulty of vacuum-assisted delivery.Statistical and predictive value analyses were performed using independent-sample t-test,U-test,Chi-square(or Fisher's exact)test,logistic regression analysis,and receiver operating characteristic(ROC)curve.ResultsA total of 162 cases were included in the study,with 120 in the easy and 42 in the difficult groups.The age of the 162 pregnant women ranged from 20 to 44 years,with an average of(30.6±3.9)years;107 cases(66.0%)were first pregnancies,and 139 cases(85.8%)were primipara.(1)The fetal head stations in the difficult and easy groups were 2.3(2.0-2.5)cm and 2.0(2.0-2.5)cm,respectively,with no statistically significant difference(P>0.05).The AOP during the interval and contraction periods and theΔAOP in the difficult group were smaller than those in the easy group[(138.1±8.8)vs.(143.8±7.9),t=3.89;(148.7±9.3)vs.(157.9±8.9),t=5.67;and(10.6±6.4)vs.(14.1±6.3),t=3.08;all P<0.01],while the HPD during the interval and contraction periods andΔHPD in the difficult group were greater than those in the easy group[(3.4±0.5)cm vs.(3.2±0.4)cm,t=-2.69;(2.8±0.5)cm vs.(2.4±

关 键 词：产时超声 产程进展角 胎头会阴距离 吸引产 

分 类 号：R714.3[医药卫生—妇产科学]