Wiafe Yaw A, Whitehead Bill, Venables Heather, Odoi Alexander T
Department of Nursing, Radiography and Healthcare, University of Derby, Derby, UK.
Department of Sonography, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Ultrasound. 2018 Feb;26(1):16-21. doi: 10.1177/1742271X18755080. Epub 2018 Feb 7.
The purpose of this study was to investigate the diagnostic performance of the head-perineum distance, angle of progression, and the head-symphysis distance as intrapartum ultrasound parameters in the determination of an engaged fetal head. Two hundred and one women in labour underwent both ultrasound and digital vaginal examination in the estimation of fetal head station. The transperineal ultrasound measured head-perineum distance, angle of progression, and head-symphysis distance for values correlating with digital vaginal examination head station. Using station 0 as the minimum level of head engagement, correlating cut-off values for head-perineum distance, angle of progression, and head-symphysis distance were obtained. Receiver operating characteristics were used in determining the diagnostic performance of these cut-off values for the detection of fetal head engagement. With head-perineum distance of 3.6 cm the sensitivity and specificity of sonographic determination of engaged fetal head were 78.7 and 72.3%, respectively. A head-symphysis distance of 2.8 cm also had sensitivity and specificity of 74.5 and 70.8%, respectively, in determining engagement, whilst an angle of progression of 101° was consistent with engagement by digital vaginal examination with 68.1% sensitivity and 68.2% specificity. Ultrasound shows high diagnostic performance in determining engaged fetal head at a head-perineum distance of ≤3.6 cm, head-symphysis distance of ≤2.8 cm, and angle of progression of ≥ 101°.
本研究的目的是调查头-会阴距离、进展角度和头-耻骨联合距离作为产时超声参数在确定胎头入盆中的诊断性能。201名临产妇女在评估胎头位置时同时接受了超声检查和阴道指诊。经会阴超声测量头-会阴距离、进展角度和头-耻骨联合距离，以获取与阴道指诊胎头位置相关的值。以0级作为胎头入盆的最低水平，得出头-会阴距离、进展角度和头-耻骨联合距离的相关临界值。采用受试者工作特征曲线来确定这些临界值在检测胎头入盆方面的诊断性能。当头-会阴距离为3.6 cm时，超声诊断胎头入盆的敏感性和特异性分别为78.7%和72.3%。头-耻骨联合距离为2.8 cm时，在确定入盆方面的敏感性和特异性分别为74.5%和70.8%，而进展角度为101°时，与阴道指诊入盆情况相符，敏感性为68.1%，特异性为68.2%。超声在确定胎头入盆方面具有较高的诊断性能，此时头-会阴距离≤3.6 cm、头-耻骨联合距离≤2.8 cm且进展角度≥101°。
