Sainz José Antonio, Borrero Carlota, Aquise Adriana, Serrano Rosa, Gutiérrez Laura, Fernández-Palacín Ana
a Department of Obstetrics and Gynecology , Valme University Hospital , Seville , Spain .
b Department of Obstetrics and Gynecology , University of Seville , Spain , and.
J Matern Fetal Neonatal Med. 2016;29(8):1348-52. doi: 10.3109/14767058.2015.1048680. Epub 2015 Jun 3.
We aim to evaluate the predictive capacity of intrapartum transperineal ultrasound (ITU) to predict cases of failure in fetal extraction in operative deliveries with vacuum. Prospective, observational study performed on 61 nulliparous women, ≥ 37 weeks, singleton pregnancies at full dilatation who underwent transperineal ultrasound before placement of vacuum to complete fetal extraction. Working on the transperineal longitudinal plane, we evaluated the following: Angle of Progression (AoP), Progression Distance (PD) and head direction. In the transverse plane, midline angle (MLA) and head-perineum distance were assessed. Vacuum extractions were classified as easy (EG) (three or less vacuum pulls), difficult (DG) (more than three vacuum pulls) or impossible (IG) (delivery completed by cesarean section). Occipito-posterior presentations were not evaluated.
Fifty-two patients were studied (26-EG, 19-DG and 7-IG). No differences in obstetric, intrapartum or neonatal characteristics were observed between study groups, with the following exceptions: weight at birth (3147 g-EG, 3523 g-DG and 3588 g-IG) and number of vacuum pulls (1.4-EG, 4.4-DG and 4.1-IG; p < 0.0005). The AoP pushing was 133.1° ± 13.6-EG, 112.8° ± 12.8-DG and 99.1° ± 8.9-IG (p < 0.0005); "head-up" direction was identified in 84.6% of EG, 36.8% of DG and 28.6% of IG (p < 0.001); PD were 37.0 ± 10.4 mm, 33.3 ± 23.3 mm and 20.8 ± 9.5 mm (p < 0.0005); MLA were 35.0° ± 19.6, 55.3° ± 24.4 and 76.0° ± 23.2 (p = 0.003); and head-perineum distances were 41.8 ± 6.6 mm, 49.2 ± 9.8 mm and 48.0 ± 3.4 mm (p = 0.072), respectively.
We have observed that the presence of an AoP with pushing <105°, a PD <25 mm, a "head-down" direction and a >45° MLA are very unfavorable ITU parameters which can be used to identify cases of high risk of fetal extraction failure in vacuum-assisted deliveries.
我们旨在评估产时经会阴超声（ITU）预测真空辅助分娩中胎儿娩出失败病例的能力。对61例≥37周、单胎妊娠、宫口开全的初产妇进行前瞻性观察研究，这些产妇在放置真空吸引器以完成胎儿娩出前接受了经会阴超声检查。在经会阴纵切面上，我们评估了以下指标：进展角度（AoP）、进展距离（PD）和头部方向。在横切面上，评估了中线角度（MLA）和头部与会阴的距离。真空吸引分娩分为容易（EG）（真空吸引3次或更少）、困难（DG）（真空吸引超过3次）或不可能（IG）（通过剖宫产完成分娩）。未评估枕后位情况。
研究了52例患者（26例EG、19例DG和7例IG）。研究组之间在产科、产时或新生儿特征方面未观察到差异，但以下情况除外：出生体重（EG组3147g、DG组3523g和IG组3588g）和真空吸引次数（EG组1.4次、DG组4.4次和IG组4.1次；p<0.0005）。用力时的AoP在EG组为133.1°±13.6、DG组为112.8°±12.8、IG组为99.1°±8.9（p<0.0005）；“抬头”方向在84.6%的EG组、36.8%的DG组和28.6%的IG组中出现（p<0.001）；PD分别为37.0±10.4mm、33.3±23.3mm和20.8±9.5mm（p<0.0005）；MLA分别为35.0°±19.6、55.3°±24.4和76.0°±23.2（p=0.003）；头部与会阴的距离分别为41.8±6.6mm、49.2±9.8mm和48.0±3.4mm（p=0.072）。
我们观察到，用力时AoP<105°、PD<25mm以及“低头”方向和MLA>45°是非常不利的ITU参数，可用于识别真空辅助分娩中胎儿娩出失败的高风险病例。
