Dîră Laurențiu Mihai, Cara Monica-Laura, Drăgușin Roxana Cristina, Nagy Rodica Daniela, Iliescu Dominic Gabriel
Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Obstetrics and Gynecology, University Emergency County Hospital Craiova, 200642 Craiova, Romania.
J Clin Med. 2022 Jun 8;11(12):3274. doi: 10.3390/jcm11123274.
Our objective was to demonstrate the role of the clinical determination of fetal head station (FHS) at term to predict the delivery mode in primiparous women before the onset of labor.
This prospective study included unselected primiparous women at term who presented at our tertiary maternity. We excluded multiparous patients, pregnancies with a planned Cesarean section, non-cephalic presentations, and multiple pregnancies. The protocol included weekly clinical examinations to assess the FHS. The results were used to describe the clinical fetal head descent at term. We correlated the fetal head station determinations at each week with labor outcome, including the evaluations performed within the week before delivery.
The data show no significant differences between vaginal (VD) and Cesarean section delivery (CS) cases regarding FHS determined at each week at term. The median determinations at the gestational ages (GW) from 37 to 41 were -2 and -3, similar between the two groups, with a more consistent difference at 41 GW: station -1 for VD compared to -3 for CS. There were significant differences between the "week before delivery" evaluations of the two groups. The determinations showed for both groups similar minimum (-5), maximum (+1), and median (-2) FHS values. Most vaginal deliveries cases presented at weekly examinations with increasing rates toward more advanced stations: from 10% at station -4 to 35% at station -1. Although we investigated a low-risk group, we found significant differences between the vaginal and Cesarean groups in terms of age, weight, and BMI. We provided a multiple logistic regression equation that considered the predictive clinical variables at term: the fetal head situation, age, weight, height, and BMI.
The clinical evaluation of fetal head station in primiparous before labor onset has a limited value regarding the prediction of the delivery mode. There is a potential benefit for the determinations performed within the week before delivery, but such a policy would require weekly assessments of the FHS at term, which is unlikely to be implemented. Another potential benefit would involve estimating labor outcomes in late-term or prolonged pregnancy. The fine tuning of the logistic prediction should be achieved by increasing the studied population and the number of centers involved before counseling primiparous women at term based on the clinical fetal engagement data.
我们的目的是证明足月时临床确定胎儿先露位置（FHS）在预测初产妇临产前分娩方式中的作用。
这项前瞻性研究纳入了在我们三级产科就诊的未经选择的足月初产妇。我们排除了经产妇、计划剖宫产的妊娠、非头位分娩和多胎妊娠。方案包括每周进行临床检查以评估FHS。结果用于描述足月时临床胎儿头部下降情况。我们将每周的胎儿先露位置测定结果与分娩结局相关联，包括分娩前一周内进行的评估。
数据显示，足月时每周测定的FHS在阴道分娩（VD）和剖宫产（CS）病例之间无显著差异。孕37至41周时的中位测定值在两组中均为-2和-3，相似，在孕41周时差异更一致：VD组为-1，而CS组为-3。两组“分娩前一周”的评估存在显著差异。两组的测定结果显示出相似的最小（-5）、最大（+1）和中位（-2）FHS值。大多数阴道分娩病例在每周检查时表现为向更低位先露的发生率增加：从-4位时的10%增至-1位时的35%。尽管我们研究的是低风险组，但我们发现阴道分娩组和剖宫产组在年龄、体重和BMI方面存在显著差异。我们提供了一个多元逻辑回归方程，该方程考虑了足月时的预测临床变量：胎儿头部情况、年龄、体重、身高和BMI。
临产前初产妇胎儿先露位置的临床评估在预测分娩方式方面价值有限。在分娩前一周内进行测定可能有益，但这样的政策需要在足月时每周评估FHS，这不太可能实施。另一个潜在益处是涉及估计晚期或过期妊娠的分娩结局。在根据临床胎儿入盆数据为足月初产妇提供咨询之前，应通过增加研究人群和参与中心的数量来实现逻辑预测的微调。
