Dimassi Kaouther, Temessek Helmi, Ben Amor Anissa, Triki Amel
Tunis Med. 2018 Jun;96(6):360-365.
To compare Transperineal (TP) and Transabdominal (TA) ultrasound in the assessment of fetal head position during the second stage of labor.
A prospective comparative Study including low risk parturients. The assessment of fetal head position was performed for each patient at full dilation. The ultrasound examination was performed by one examiner using TP technique first then TA. A routine digital vaginal examination was performed by a different examiner blinded to ultrasound findings. Considering TA as reference, the three methods were compared.
Fifty two patients were enrolled in the study group. Agreement between the clinical examination and TA ultrasound was average with Kappa index = 0.579. Agreement between TA and TP Ultrasound was good with Kappa index = 0.766. TP technique was accurate in the diagnosis of fetal head position (sensitivity =91.3%, specificity=98.38%, PPV=87.5%, NPV=98.91%). TA ultrasound was the most reliable method in case of high presentations. For lower fetal presentations, the TP approach was more relevant.
Assuming that an accurate diagnosis of fetal head position is required before any instrumental delivery where, by definition, fetal presentation is engaged, the TP ultrasound is advised. In a single time this technique provides the necessary information about the station, and the position of the fetal head.
比较经会阴超声（TP）和经腹超声（TA）在分娩第二产程中评估胎头位置的效果。
一项纳入低风险产妇的前瞻性对照研究。在宫口开全时对每位患者进行胎头位置评估。由一名检查者先采用TP技术然后采用TA技术进行超声检查。由另一名对超声检查结果不知情的检查者进行常规的阴道指检。以TA超声作为参照，对三种方法进行比较。
52例患者纳入研究组。临床检查与TA超声之间的一致性一般，Kappa指数=0.579。TA超声与TP超声之间的一致性良好，Kappa指数=0.766。TP技术在诊断胎头位置方面准确（敏感性=91.3%，特异性=98.38%，阳性预测值=87.5%，阴性预测值=98.91%）。对于高先露情况，TA超声是最可靠的方法。对于较低的胎儿先露情况，TP方法更适用。
假设在任何器械助产之前都需要准确诊断胎头位置，而根据定义此时胎儿先露已衔接，建议采用TP超声。该技术能一次性提供关于胎头的位置及入盆情况的必要信息。
