Gillor M, Vaisbuch E, Zaks S, Barak O, Hagay Z, Levy R
Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel.
Ultrasound Obstet Gynecol. 2017 Feb;49(2):240-245. doi: 10.1002/uog.15931.
To assess whether measurement of the angle of progression (AOP) before induction of labor (IOL) can predict successful vaginal delivery in nulliparous women.
This was a prospective, observational study of nulliparous women with a singleton term pregnancy and an indication for IOL. Transperineal sonography was used to measure the AOP before cervical ripening. Since all women enrolled had a low Bishop score, 98.6% of them were induced with either intracervical extra-amniotic balloon catheter or vaginal prostaglandin E-2. The staff in the labor ward were blinded to the AOP measurements. Clinical data were retrieved from computerized medical records.
Of the 150 women included in the final analysis, 40 (26.7%) delivered by Cesarean section. The median AOP was narrower in women who had a Cesarean delivery than in those who delivered vaginally (90° (interquartile range (IQR), 84-94.5°) vs 98° (IQR, 90.8-105°); P < 0.001). When including only women who underwent Cesarean delivery for non-progression of labor (n = 27) in the analysis, an AOP of > 92° (derived from a receiver-operating characteristics curve) was associated with a successful vaginal delivery in 94.8% of women. Multivariate stepwise logistic regression analysis including maternal age, body mass index, gestational age, estimated fetal weight, fetal head station, indication for IOL and AOP demonstrated that only AOP was independently associated with the prediction of a successful induction.
AOP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at term undergoing IOL; an AOP wider than 92° is associated with a high rate of vaginal delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
评估引产（IOL）前进展角度（AOP）的测量能否预测初产妇成功阴道分娩。
这是一项对单胎足月妊娠且有引产指征的初产妇进行的前瞻性观察研究。在宫颈成熟前，采用经会阴超声测量AOP。由于所有纳入的女性Bishop评分均较低，其中98.6%的女性采用宫颈内羊膜外球囊导管或阴道前列腺素E-2引产。产房工作人员对AOP测量结果不知情。临床数据从计算机化医疗记录中获取。
在最终分析纳入的150名女性中，40名（26.7%）行剖宫产分娩。剖宫产分娩女性的AOP中位数比阴道分娩女性更窄（90°（四分位间距（IQR），84 - 94.5°） vs 98°（IQR，90.8 - 105°）；P < 0.001）。在分析中仅纳入因产程无进展而行剖宫产分娩的女性（n = 27）时，AOP > 92°（源自受试者工作特征曲线）与94.8%的女性成功阴道分娩相关。多因素逐步逻辑回归分析包括产妇年龄、体重指数、孕周、估计胎儿体重、胎头位置、引产指征和AOP，结果显示只有AOP与引产成功预测独立相关。
AOP可能是预测足月行IOL的初产妇成功阴道分娩的一个有用的超声参数；AOP大于92°与高阴道分娩率相关。版权所有© 2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
