Eggebø T M, Hassan W A, Salvesen K Å, Lindtjørn E, Lees C C
Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway; National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway.
Ultrasound Obstet Gynecol. 2014 Feb;43(2):195-201. doi: 10.1002/uog.13210. Epub 2013 Dec 22.
To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP).
This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line through the long axis of the symphysis and the tangent to the fetal head) and transabdominal ultrasound to classify fetal head position. The main outcomes were vaginal delivery and time remaining in labor.
Of 150 women enrolled, 39 underwent delivery by Cesarean section. The area under the receiver-operating characteristics curve for the prediction of vaginal delivery was 81% (95% CI, 73-89%) using HPD as the test variable and 72% (95% CI, 63-82%) using AoP. HPD was ≤ 40 mm in 84 (56%) women, of whom 77 (92%; 95% CI, 84-96%) delivered vaginally. HPD was > 40 mm in the other 66 (44%) women, of whom 34 (52%; 95% CI, 40-63%) delivered vaginally. AoP was ≥ 110° in 84 of the 145 (58%) in whom this was available and, of these, 74 (88%; 95% CI, 79-93%) delivered vaginally. AoP was < 110° in the other 61 (42%) women, of whom 35 (57%; 95% CI, 45-69%) delivered vaginally. Multivariable logistic regression analysis showed that HPD ≤ 40 mm (odds ratio (OR), 4.92; 95% CI, 1.54-15.80), AoP ≥ 110° (OR, 3.11; 95% CI, 1.01-9.56), non-occiput posterior position (OR, 3.36; 95% CI, 1.24-9.12) and spontaneous onset of labor (OR, 4.44; 95% CI, 1.42-13.89) were independent predictors for vaginal delivery. Both ultrasound methods were predictive for the time remaining in labor.
Transperineal ultrasound measurement of HPD and AoP provide important information about the likelihood of vaginal delivery and the time remaining in labor in nulliparous women with prolonged labor.
探讨经会阴超声测量的头-会阴距离（HPD）能否预测初产妇第一产程延长时的阴道分娩及剩余产程时间，并将其预测价值与进展角度（AoP）进行比较。
这是一项前瞻性观察研究，于2012年1月至2013年4月在挪威斯塔万格大学医院和英国剑桥阿登布鲁克医院对足月单胎头先露、第一产程延长的初产妇进行。我们使用经会阴超声测量HPD（胎儿颅骨外骨性界限与会阴之间的最短距离）和AoP（耻骨联合长轴与胎儿头部切线之间的夹角），并使用经腹超声对胎儿头部位置进行分类。主要结局为阴道分娩及剩余产程时间。
150名纳入研究的女性中，39例行剖宫产。以HPD作为检验变量预测阴道分娩的受试者工作特征曲线下面积为81%（95%CI，73 - 89%），以AoP作为检验变量时为72%（95%CI，63 - 82%）。84名（56%）女性的HPD≤40mm，其中77名（92%；95%CI，84 - 96%）经阴道分娩。另外66名（44%）女性的HPD>40mm，其中34名（52%；95%CI，4 – 63%）经阴道分娩。在可测量AoP的145名女性中，84名（58%）的AoP≥110°，其中74名（88%；95%CI，79 - 93%）经阴道分娩。另外61名（42%）女性的AoP<110°，其中35名（57%；95%CI，45 - 69%）经阴道分娩。多变量逻辑回归分析显示，HPD≤40mm（优势比（OR），4.92；95%CI，1.54 - 15.80）、AoP≥110°（OR，3.11；95%CI，1.01 - 9.56）、非枕后位（OR，3.36；95%CI，1.24 - 9.12）和自然发动分娩（OR，4.44；95%CI，1.42 - 13.89）是阴道分娩的独立预测因素。两种超声方法均能预测剩余产程时间。
经会阴超声测量HPD和AoP可为初产妇产程延长时的阴道分娩可能性及剩余产程时间提供重要信息。
