Department of Obstetrics, Charité University Hospital, Campus Benjamin Franklin and Campus Charité Mitte, Berlin, Germany.
Ultrasound Obstet Gynecol. 2010 Feb;35(2):216-22. doi: 10.1002/uog.7521.
To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience.
One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with < 5 years' experience and three obstetricians with > 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland-Altman analysis was used to assess interobserver agreement.
In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63-0.81). ICCs were 0.82 (95% CI, 0.70-0.89), 0.81 (95% CI, 0.71-0.88) and 0.61 (95% CI, 0.43-074) for observers with > 10 years', < 5 years' and no ultrasound experience, respectively. There were no significant differences between ICCs among observer groups according to ultrasound experience. Fetal head station did not affect reliability. Bland-Altman analysis indicated reasonable agreement between measurements obtained by two different operators with > 10 years' and < 5 years' ultrasound experience (bias, -1.09 degrees ; 95% limits of agreement, -8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70-0.93).
Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience.
评估在由一位经验丰富的操作者进行的产程中经会阴超声图像上，胎儿先露下降的测量中，超声经验或胎儿先露位置是否会影响进展角的可靠性，以及在不同经验的操作者获取图像时测量的可靠性。
一位经验丰富的产科医生对处于足月且第二产程延长的枕前位胎儿的 44 名妇女进行了 44 次经会阴超声检查。3 名无超声经验的助产士、3 名超声经验不足 5 年的产科医生和 3 名超声经验超过 10 年的产科医生根据图像上的进展角来测量胎儿先露下降的程度。由两位产科医生在 24 名处于足月且胎头位置的临产妇女的独立经会阴超声检查中测量进展角，以评估图像采集的可靠性。使用 95%置信区间（CI）的组内相关系数（ICC）评估观察者间可靠性，使用 Bland-Altman 分析评估观察者间一致性。
总共进行了 444 次测量并进行了比较。离线图像分析的观察者间可靠性为中等（总体 ICC，0.72；95%CI，0.63-0.81）。观察者经验超过 10 年、不足 5 年和无超声经验的 ICC 分别为 0.82（95%CI，0.70-0.89）、0.81（95%CI，0.71-0.88）和 0.61（95%CI，0.43-074）。根据超声经验，观察者组之间的 ICC 没有显著差异。胎儿先露位置不影响可靠性。Bland-Altman 分析表明，具有超过 10 年和不足 5 年超声经验的两位不同操作者获得的测量值之间存在合理的一致性（偏差，-1.09°；95%一致性区间，-8.76 至 6.58）。两位经验丰富的操作者分别进行图像采集后的进展角测量的可靠性与离线图像分析的可靠性相似（ICC，0.86；95%CI，0.70-0.93）。
无论胎儿先露位置或临床医生的超声经验水平如何，经会阴超声成像上进展角的测量都是可靠的。
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