Wiafe Yaw A, Whitehead Bill, Venables Heather, Dassah Edward T, Eggebø Torbjørn M
College of Health and Social Care, University of Derby, Derby, UK.
Department of Sonography, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
J Ultrasound. 2018 Sep;21(3):233-239. doi: 10.1007/s40477-018-0309-2. Epub 2018 Jul 28.
We aimed to examine the agreement between ultrasound and digital vaginal examination in assessing cervical dilatation in an African population and to assess the value of ultrasound in detecting active labor.
A cross-sectional study was conducted in a teaching hospital in Ghana between April and September of 2016. Anterior-posterior and transverse diameters of cervical dilatation were measured with ultrasound and the mean value was compared with digital vaginal examination in 195 women in labor. Agreement between methods was examined with correlation coefficients and with Bland-Altman plots. Active labor was defined when cervix was dilated ≥ 4 cm with vaginal examinations. ROC curve analysis was conducted on the diagnostic performance of ultrasound in detecting active labor.
Data were analyzed in 175 out of 195 (90%) cases where ultrasound could clearly visualize the cervix. The remaining 20 cases were all determined by digital vaginal examination as advanced cervical dilatation (≥ 8 cm), advanced head station (≥ + 2), and with ruptured membranes. The Pearson correlation coefficient (r) was 0.78 (95% CI 0.72-0.83) and the intra-class correlation coefficient was 0.76 (95% CI 0.69-0.81). Bland-Altman analysis obtained a mean difference of - 0.03 cm (95% CI - 0.18 to 0.12) with zero included in the CI intervals, indicating no significant difference between methods. Limits of agreement were from - 2.01 to 1.95 cm. Ultrasound predicted active labor with 0.87 (95% CI 0.75-0.99) as the area under the ROC curve.
Ultrasound measurements showed good agreement with digital vaginal examinations in assessing cervical dilatation during labor and ultrasound may be used to detect active labor.
我们旨在研究超声检查与指诊在评估非洲人群宫颈扩张情况时的一致性，并评估超声在检测活跃期分娩中的价值。
2016年4月至9月间，在加纳的一家教学医院开展了一项横断面研究。对195名分娩妇女采用超声测量宫颈扩张的前后径和横径，并将平均值与指诊结果进行比较。通过相关系数和Bland-Altman图来检验两种方法之间的一致性。指诊时宫颈扩张≥4 cm则定义为活跃期分娩。对超声检测活跃期分娩的诊断性能进行ROC曲线分析。
195例中有175例（90%）的数据进行了分析，这些病例中超声能够清晰显示宫颈。其余20例均通过指诊确定为宫颈扩张晚期（≥8 cm）、胎头高位（≥+2）且胎膜已破。Pearson相关系数（r）为0.78（95%CI 0.72 - 0.83），组内相关系数为0.76（95%CI 0.69 - 0.81）。Bland-Altman分析得出平均差值为 -0.03 cm（95%CI -0.18至0.12），CI区间包含零，表明两种方法之间无显著差异。一致性界限为 -2.01至1.95 cm。超声预测活跃期分娩的ROC曲线下面积为0.87（95%CI 0.75 - 0.99）。
超声测量在评估分娩期间宫颈扩张情况时与指诊显示出良好的一致性，且超声可用于检测活跃期分娩。
