Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Cairo, Egypt.
J Matern Fetal Neonatal Med. 2020 Sep;33(18):3163-3169. doi: 10.1080/14767058.2019.1570113. Epub 2019 Jan 30.
The aim of the present study was two-fold; first is to assess the impact of a theoretical and practical course on the caregiver's perspective on the use of ultrasound in labor. Second is to evaluate the impact of the course on the measurement of the angle of progression. Obstetricians participating in the course responded twice to a questionnaire addressing the caregiver's perspective on the use of ultrasound in labor, before and at the end of the course. In addition, all participants measured the angle of progression on a digital simulation software once following the theoretical part and a second time after the conclusion of both the theoretical and practical sessions. All answers to the questionnaire were compared before versus after the course. The angle of progression assessments after the theoretical part and those after the course were compared with those performed by an expert operator. Overall, data from 51 participants were analyzed. In comparison with the pre-course questionnaire, more participants after the course believed ultrasound can be a useful instrument for fetal occiput presentation diagnosis (45; 88.2% versus 26; 51%, < .001) and for fetal head progression evaluation (37; 72.5% versus 19; 37.3%; < .001). Although before the course, most participants (32; 62.7%) thought that the transperineal parameters were too complex to be applied, only 19 (37.3%) still considered the complexity of the ultrasound indices, an obstacle against their application in clinical practice after the course ( = .002). Regarding the angle of progression, precourse measurements showed a systematic overestimation in comparison with the gold standard. Furthermore, the coefficient of variation, more than halved following the practical simulation reflecting at least a doubling of the angle of progression (AoP) measurement precision (14.2 versus 5.5%). A theoretical and practical course conducted by expert operators may positively change obstetricians' perspective on the use of ultrasound in labor. Moreover, a practical session seems to improve the participants' accuracy and precision in the assessment of fetal head descent by transperineal ultrasound.
本研究的目的有两个；首先是评估理论与实践课程对护理人员对产程中超声应用的看法的影响。其次是评估该课程对进展角度测量的影响。参加该课程的产科医生在课程开始前和结束时两次回答了一份关于护理人员对产程中超声应用看法的问卷。此外，所有参与者在理论部分之后和理论与实践部分结束后都在数字模拟软件上测量了一次进展角度。对问卷的所有答案都在课程前后进行了比较。理论部分后的进展角度评估与课程后的评估与专家操作员的评估进行了比较。总体而言，对 51 名参与者的数据进行了分析。与课前问卷相比，更多的参与者在课后认为超声可以成为胎儿枕骨位置诊断的有用工具（45 名；88.2% 对 26 名；51%，<0.001）和胎儿头部进展评估（37 名；72.5% 对 19 名；37.3%，<0.001）。尽管在课程开始前，大多数参与者（32 名；62.7%）认为经会阴参数过于复杂而无法应用，但只有 19 名（37.3%）在课后仍认为超声指标的复杂性是阻碍其在临床实践中应用的障碍（=0.002）。关于进展角度，课前测量与金标准相比存在系统性高估。此外，实践模拟后变异系数减少了一半以上，这至少反映了进展角度（AoP）测量精度提高了一倍（14.2 对 5.5%）。由专家操作员进行的理论与实践课程可能会改变产科医生对产程中超声应用的看法。此外，实践课程似乎提高了参与者经会阴超声评估胎儿头部下降的准确性和精密度。
