产时经会阴超声用于预测初产妇复杂手术分娩（真空吸引和产钳助产）的病例。
Intrapartum transperineal ultrasound used to predict cases of complicated operative (vacuum and forceps) deliveries in nulliparous women.
作者信息
Sainz José A, García-Mejido José A, Aquise Adriana, Bonomi María J, Borrero Carlota, De La Fuente Paloma, Fernández-Palacín Ana
机构信息
Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.
出版信息
Acta Obstet Gynecol Scand. 2017 Dec;96(12):1490-1497. doi: 10.1111/aogs.13230.
INTRODUCTION
The objective of this study was to investigate the predictive value of intrapartum transperineal ultrasound in the identification of complicated operative (vacuum or forceps) deliveries in nulliparous women.
MATERIAL AND METHODS
Prospective observational study of nulliparous women with an indication for operative delivery who underwent intrapartum transperineal ultrasound before fetal extraction. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound was performed immediately before blade application, both at rest and concurrently with contractions and active pushing. Operative delivery was classified as complicated when one or more of the following situations occurred: three or more tractions; a third-/fourth-degree perineal tear; significant bleeding during the episiotomy repair; major tear or significant traumatic neonatal lesion.
RESULTS
A total of 143 nulliparous women were included in the study (82 vacuum-assisted deliveries and 61 forceps-assisted deliveries), with 20 fetuses in occiput posterior position. Forty-seven operative deliveries were classified as complicated deliveries (28 vacuum-assisted deliveries, 19 forceps-assisted deliveries). No differences in obstetric, intrapartum or neonatal characteristics were observed between the study groups, with the following exceptions: birthweight (3229 ± 482 uncomplicated deliveries vs. 3623 ± 406 complicated deliveries; p < 0.003) and number of vacuum tractions (1.4 uncomplicated deliveries, 4.5 complicated deliveries; p < 0.0005). The strongest predictors of a complicated delivery, using the area under the receiver-operating characteristics curve (AUC), were the angle of progression with active pushing (AoP2) (AUC 86.9%) and the progression distance with active pushing (PD2) (AUC 74.5%). The optimal cut-off value for predicting a difficult operative delivery was an AoP2 of 153.5° (sensitivity 95.2%; false-positive rate 5.9%) or PD2 of 58.5 mm (sensitivity 95.2%; false-positive rate 7.1%).
CONCLUSIONS
The sonographic parameters AoP2 and PD2 can be used to predict cases of complicated operative deliveries in nulliparous women.
引言
本研究的目的是探讨产时经会阴超声在识别初产妇复杂手术分娩（真空吸引或产钳助产）中的预测价值。
材料与方法
对有手术分娩指征的初产妇进行前瞻性观察研究，这些产妇在胎儿娩出前接受了产时经会阴超声检查。产科主管医生对超声数据不知情。在放置产钳前立即进行产时经会阴超声检查，分别在静息状态、宫缩时及主动屏气时进行。当出现以下一种或多种情况时，手术分娩被分类为复杂分娩：三次或更多次牵引；三度/四度会阴撕裂；会阴切开术修复过程中大量出血；严重撕裂或重大创伤性新生儿损伤。
结果
本研究共纳入143例初产妇（82例真空吸引助产分娩和61例产钳助产分娩），其中20例胎儿为枕后位。47例手术分娩被分类为复杂分娩（28例真空吸引助产分娩，19例产钳助产分娩）。研究组之间在产科、产时或新生儿特征方面未观察到差异，但有以下例外：出生体重（非复杂分娩为3229±482，复杂分娩为3623±406；p<0.003）和真空吸引次数（非复杂分娩为1.4次，复杂分娩为4.5次；p<0.0005）。使用受试者操作特征曲线下面积（AUC），复杂分娩的最强预测因素是主动屏气时的进展角度（AoP2）（AUC 86.9%）和主动屏气时的进展距离（PD2）（AUC 74.5%）。预测困难手术分娩的最佳截断值为AoP2为153.5°（敏感性95.2%；假阳性率5.9%）或PD2为58.5mm（敏感性95.2%；假阳性率7.1%）。
结论
超声参数AoP2和PD2可用于预测初产妇复杂手术分娩的情况。
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