Dupuis Olivier, Ruimark Silveira, Corinne Dupont, Simone Thevenet, André Dittmar, René-Charles Rudigoz
Unité de Gynécologie Obstétrique, Hôpital de la Croix Rousse, 103 Grande-Rue de la Croix Rousse, 69317 Lyon Cedex 04, France.
Eur J Obstet Gynecol Reprod Biol. 2005 Dec 1;123(2):193-7. doi: 10.1016/j.ejogrb.2005.04.009. Epub 2005 May 31.
To study the correlation between digital vaginal and transabdominal ultrasonographic examination of the fetal head position during the second stage of labor.
Patients (n = 110) carrying a singleton fetus in a vertex position were included. Every patient had ruptured membranes and a fully dilated cervix. Transvaginal examination was randomly performed either by a senior resident or an attending consultant. Immediately afterwards, transabdominal ultrasonography was performed by the same sonographer (OD). Both examiners were blind to each other's results. Sample size was determined by power analysis. Confidence intervals around observed rates were compared using chi-square analysis and Cohen's Kappa test. Logistic regression analysis was performed.
In 70% of cases, both clinical and ultrasound examinations indicated the same position of the fetal head (95% confidence interval, 66-78). Agreement between the two methods reached 80% (95% CI, 71.3-87) when allowing a difference of up to 45 degrees in the head rotation. Logistic regression analysis revealed that gestational age, parity, birth weight, pelvic station and examiner's experience did not significantly affect the accuracy of the examination. Caput succedaneum tended to diminish (p = 0.09) the accuracy of clinical examination. The type of fetal head position significantly affected the results. Occiput posterior and transverse head locations were associated with a significantly higher rate of clinical error (p = 0.001).
In 20% of the cases, ultrasonographic and clinical results differed significantly (i.e., >45 degrees). This rate reached 50% for occiput posterior and transverse locations. Transabdominal ultrasonography is a simple, quick and efficient way of increasing the accuracy of the assessment of fetal head position during the second stage of labor.
研究第二产程中经阴道与经腹超声检查胎儿头部位置的相关性。
纳入110例单胎头先露患者。所有患者均已破膜且宫颈完全扩张。经阴道检查由一名高年住院医师或主治顾问医师随机进行。随后，由同一名超声医师（OD）进行经腹超声检查。两位检查者均对彼此的结果不知情。样本量通过功效分析确定。使用卡方分析和科恩卡帕检验比较观察率的置信区间。进行逻辑回归分析。
在70%的病例中，临床检查和超声检查显示胎儿头部位置相同（95%置信区间，66 - 78）。当允许头部旋转角度差异达45度时，两种方法的一致性达到80%（95%CI，71.3 - 87）。逻辑回归分析显示，孕周、产次、出生体重、骨盆平面和检查者经验对检查准确性无显著影响。头皮水肿倾向于降低（p = 0.09）临床检查的准确性。胎儿头部位置类型对结果有显著影响。枕后位和横位的临床错误率显著更高（p = 0.001）。
在20%的病例中，超声检查结果与临床结果差异显著（即>45度）。枕后位和横位的这一比例达50%。经腹超声检查是提高第二产程中胎儿头部位置评估准确性的一种简单、快速且有效的方法。
