Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
Department of Obstetrics and Gynecology, St Joseph Krankenhaus, Berlin, Germany.
Ultrasound Obstet Gynecol. 2023 Jan;61(1):93-98. doi: 10.1002/uog.24981.
To evaluate the relationship between the fetal head-circumference-to-maternal-height (HC/MH) ratio measured shortly before delivery and the occurrence of Cesarean section (CS) for labor dystocia.
This was a multicenter prospective cohort study involving four tertiary maternity hospitals. An unselected cohort of women with a singleton fetus in cephalic presentation, at a gestational age beyond 36 + 0 weeks and without any contraindication for vaginal delivery, was enrolled between September 2020 and November 2021. The MH and fetal HC were measured on admission of the patient to the labor ward. The primary outcome of the study was the performance of the HC/MH ratio in the prediction of CS for labor dystocia. Women who underwent CS for any indication other than failed labor progression, including fetal distress, were excluded from the final analysis.
A total of 783 women were included in the study. Vaginal delivery occurred in 744 (95.0%) women and CS for labor dystocia in 39 (5.0%). CS for labor dystocia was associated with shorter MH (mean ± SD, 160.4 ± 6.6 vs 164.5 ± 6.3 cm; P < 0.001), larger fetal HC (339.6 ± 9.5 vs 330.7 ± 13.0 mm; P < 0.001) and a higher HC/MH ratio (2.12 ± 0.11 vs 2.01 ± 0.10; P < 0.001) compared with vaginal delivery. Multivariate logistic regression analysis showed that the HC/MH ratio was associated independently with CS for labor dystocia (adjusted odds ratio, 2.65 (95% CI, 1.85-3.79); P < 0.001). The HC/MH ratio had an area under the receiver-operating-characteristics curve of 0.77 and an optimal cut-off value for discriminating between vaginal delivery and CS for labor dystocia of 2.09, which was associated with a sensitivity of 0.62 (95% CI, 0.45-0.77), specificity of 0.79 (95% CI, 0.76-0.82), positive predictive value of 0.13 (95% CI, 0.09-0.19) and negative predictive value of 0.98 (95% CI, 0.96-0.99).
In a large cohort of unselected pregnancies, the HC/MH ratio performed better than did fetal HC and MH alone in identifying those cases that will undergo CS for labor dystocia, albeit with moderate predictive value. The HC/MH ratio could assist in the evaluation of women at risk for CS for labor dystocia. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
评估分娩前短时间内测量的胎儿头围与产妇身高比（HC/MH）与因产程延长行剖宫产术（CS）的关系。
这是一项多中心前瞻性队列研究，涉及四家三级妇产医院。2020 年 9 月至 2021 年 11 月期间，纳入了胎方位为头位、孕周超过 36+0 周且无阴道分娩禁忌证的单胎妊娠孕妇。患者入院时测量产妇身高和胎儿 HC。本研究的主要结局是 HC/MH 比值预测因产程延长行 CS 的表现。排除因胎儿窘迫等除产程进展失败以外的其他原因行 CS 的患者。
共纳入 783 例患者。744 例（95.0%）孕妇行阴道分娩，39 例（5.0%）因产程延长行 CS。与阴道分娩相比，因产程延长行 CS 与 MH 更短（均值±标准差，160.4±6.6 比 164.5±6.3cm；P<0.001）、胎儿 HC 更大（339.6±9.5 比 330.7±13.0mm；P<0.001）和 HC/MH 比值更高（2.12±0.11 比 2.01±0.10；P<0.001）。多变量 logistic 回归分析显示，HC/MH 比值与因产程延长行 CS 独立相关（调整比值比，2.65（95%CI，1.85-3.79）；P<0.001）。HC/MH 比值的受试者工作特征曲线下面积为 0.77，区分阴道分娩与因产程延长行 CS 的最佳截断值为 2.09，其鉴别阴道分娩与因产程延长行 CS 的敏感度为 0.62（95%CI，0.45-0.77），特异度为 0.79（95%CI，0.76-0.82），阳性预测值为 0.13（95%CI，0.09-0.19），阴性预测值为 0.98（95%CI，0.96-0.99）。
在一个大型未选择的孕妇队列中，HC/MH 比值在识别因产程延长行 CS 的病例方面优于胎儿 HC 和 MH 单独使用，尽管其预测价值中等。HC/MH 比值可有助于评估有因产程延长行 CS 风险的孕妇。
