Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides K H
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, London, UK.
Ultrasound Obstet Gynecol. 2003 May;21(5):437-40. doi: 10.1002/uog.103.
To investigate the accuracy of intrapartum transvaginal digital examination in defining the position of the fetal head before instrumental delivery.
In 64 singleton pregnancies undergoing instrumental delivery the fetal head position was determined by transvaginal digital examination by the attending obstetrician. Immediately after or before the clinical examination, the fetal head position was determined by transabdominal ultrasound by a trained sonographer who was not aware of the clinical findings. The digital examination was considered to be correct if the fetal head position was within +/- 45 degrees of the ultrasound finding. The accuracy of the digital examination was examined in relation to maternal and fetal characteristics.
Digital examination failed to define the correct fetal head position in 17 (26.6%) cases. In 12 of 17 (70.6%) errors the difference was >/= 90 degrees and in five (29.4%) the difference was between 45 degrees and 90 degrees. The accuracy of vaginal digital examination was 83% for occiput-anterior and 54% for occiput-lateral + occiput-posterior positions. Logistic regression analysis demonstrated significant independent contributions in explaining the variance in the accuracy of vaginal examination for the station of the fetal head, the position of the fetal head and the experience of the examining obstetrician.
Digital examination during instrumental delivery fails to identify the correct fetal head position in about one quarter of cases.
探讨产时经阴道指诊在器械助产术前确定胎头位置的准确性。
对64例单胎妊娠行器械助产术的产妇，由主治产科医生经阴道指诊确定胎头位置。在临床检查之后或之前，由一名不知临床检查结果的受过培训的超声医师经腹部超声确定胎头位置。如果胎头位置与超声检查结果相差在±45度以内，则认为指诊正确。根据母体和胎儿特征对指诊的准确性进行检查。
17例（26.6%）指诊未能确定正确的胎头位置。在17例错误中，12例（70.6%）相差≥90度，5例（29.4%）相差在45度至90度之间。枕前位时经阴道指诊的准确性为83%，枕侧位+枕后位时为54%。逻辑回归分析表明，胎头先露部位、胎头位置及检查产科医生的经验对解释阴道检查准确性的差异有显著的独立作用。
器械助产术时的指诊在约四分之一的病例中无法确定正确的胎头位置。
