Albrich S, Laterza R M, Merinsky A, Skala C, Koelbl H, Naumann G
Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Johannes-Gutenberg-Universität.
OB/GYN, University Mainz.
Ultraschall Med. 2012 Dec;33(7):E95-E100. doi: 10.1055/s-0031-1299053. Epub 2012 Jun 21.
Ultrasound has achieved an indispensable role in urogynecology. The introduction of 3 D technology has enabled sonographers to visualize structures in the axial plane. The angle of the infrapubic arc may enable us to presume the shape of the pelvis. Our aim was to describe a method for measuring the infrapubic angle and the interpubic space with 3 D perineal ultrasound through 3 D rotation, correlating them with the length of the 2nd stage of labor and the rate of levator defects.
Women after vaginal delivery were recruited and underwent a 3 D perineal ultrasound on 2nd - 3 rd day postpartum. Volume datasets were analyzed to measure the infrapubic angle and the interpubic space independently by 2 urogynecologists. The interobserver reliability and the correlation between infrapubic arc angle and the length of the 2nd stage of labor and the occurrence of levator defects were calculated.
110 women were enrolled. With a correlation coefficient of 0.76, the relationship between the infrapubic angle measurements of the two observers was very good. A moderate to good correlation was found for the assessment of the interpubic gap, with r = 0.69. Between the infrapubic angle and length of the 2nd stage of labor, no statistical correlation for both observer measurements (p = 0.31; p = 0.78, respectively) was found. Also the correlation between the infrapubic arc angle and the occurrence of levator avulsions was not significant (p = 0.59; p = 0.39, respectively).
3 D ultrasound technology enables us to identify and evaluate the interpubic gap and the infrapubic arc with a high inter-observer reproducibility. However, from our data, the infrapubic angle does not seem to influence the length of the 2nd stage of labor and the occurrence of levator defects.
超声在女性盆底疾病诊治中发挥着不可或缺的作用。三维（3D）技术的引入使超声检查人员能够在轴平面上观察组织结构。耻骨下弧的角度可能有助于我们推测骨盆的形态。我们的目的是描述一种通过三维旋转利用三维会阴超声测量耻骨下角度和耻骨间隙的方法，并将其与第二产程的时长及肛提肌损伤发生率相关联。
招募经阴道分娩后的女性，于产后第2至3天接受三维会阴超声检查。由两名女性盆底疾病专家独立分析容积数据集，测量耻骨下角度和耻骨间隙。计算观察者间的可靠性以及耻骨下弧角度与第二产程时长和肛提肌损伤发生率之间的相关性。
共纳入110名女性。两名观察者对耻骨下角度测量值之间的相关系数为0.76，相关性非常好。耻骨间隙评估的相关性为中度到良好，r = 0.69。在耻骨下角度与第二产程时长之间，两名观察者的测量结果均未发现统计学相关性（p值分别为0.31和0.78）。耻骨下弧角度与肛提肌撕裂发生率之间的相关性也不显著（p值分别为0.59和0.39）。
三维超声技术使我们能够识别和评估耻骨间隙及耻骨下弧，观察者间的可重复性很高。然而，根据我们的数据，耻骨下角度似乎并不影响第二产程的时长及肛提肌损伤的发生。
