Bellussi Federica, Ghi Tullio, Youssef Aly, Salsi Ginevra, Giorgetta Francesca, Parma Dila, Simonazzi Giuliana, Pilu Gianluigi
Departments of Obstetrics and Gynecology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.
Departments of Obstetrics and Gynecology, University of Parma, Ospedale Maggiore, Parma, Italy.
Am J Obstet Gynecol. 2017 Dec;217(6):633-641. doi: 10.1016/j.ajog.2017.07.025. Epub 2017 Jul 22.
Fetal malpositions and cephalic malpresentations are well-recognized causes of failure to progress in labor. They frequently require operative delivery, and are associated with an increased probability of fetal and maternal complications. Traditional obstetrics emphasizes the role of digital examinations, but recent studies demonstrated that this approach is inaccurate and intrapartum ultrasound is far more precise. The objective of this review is to summarize the current body of literature and provide recommendations to identify malpositions and cephalic malpresentations with ultrasound. We propose a systematic approach consisting of a combination of transabdominal and transperineal scans and describe the findings that allow an accurate diagnosis of normal and abnormal position, flexion, and synclitism of the fetal head. The management of malpositions and cephalic malpresentation is currently a matter of debate, and individualized depending on the general clinical picture and expertise of the provider. Intrapartum sonography allows a precise diagnosis and therefore offers the best opportunity to design prospective studies with the aim of establishing evidence-based treatment. The article is accompanied by a video that demonstrates the sonographic technique and findings.
胎位异常和头先露异常是公认的产程进展受阻的原因。它们常常需要手术分娩，并且与胎儿和母体并发症的发生几率增加相关。传统产科强调指诊的作用，但最近的研究表明这种方法不准确，而产时超声更为精确。本综述的目的是总结当前的文献，并提供利用超声识别胎位异常和头先露异常的建议。我们提出一种由经腹扫查和经会阴扫查相结合的系统方法，并描述能够准确诊断胎儿头部正常和异常位置、俯屈及胎头倾度的检查结果。胎位异常和头先露异常的处理目前存在争议，需根据总体临床情况和医疗人员的专业知识进行个体化处理。产时超声检查能够进行精确诊断，因此为开展旨在确立循证治疗的前瞻性研究提供了最佳契机。本文配有一段展示超声检查技术及检查结果的视频。
