Fidalgo Ana M, Miguel Raquel, Fernández-Buhigas Irene, Aguado Asunción, Cuerva Marcos J, Corrales Elisa, Rolle Valeria, Santacruz Belén, Gil María M, Poon Liona C
Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain.
Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain.
Int J Gynaecol Obstet. 2024 Jan;164(1):131-139. doi: 10.1002/ijgo.14956. Epub 2023 Jul 4.
To evaluate the level of agreement between ultrasound measurements to evaluate fetal head position and progress of labor by attending midwives and obstetricians after appropriate training.
In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head-to-perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position.
We found a good correlation between the AoP measured by obstetricians and midwives (intra-class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80-0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68-0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91-0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen's κ = 0.89; 95% CI 0.80-0.98).
Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.
评估经过适当培训的助产士和产科医生通过超声测量评估胎儿头部位置及产程进展的一致性水平。
在这项前瞻性研究中，邀请了2018年3月至2019年12月期间在我们产科病房分娩单胎头先露的第一产程妇女参与；109名妇女同意参加。由一名经过培训的助产士和一名产科医生独立进行经会阴和经腹超声检查。在107例中可获得两组配对测量值用于比较进展角度（AoP），106例用于头到会阴距离（HPD），97例用于宫颈扩张（CD），79例用于胎儿头部位置。
我们发现产科医生和助产士测量的AoP之间存在良好的相关性（组内相关系数[ICC]=0.85；95%置信区间[CI]0.80 - 0.89）。HPD之间存在中等相关性（ICC = 0.75；95% CI 0.68 - 0.82）。测量的CD之间存在非常好的相关性（ICC = 0.94；95% CI 0.91 - 0.96）。在胎儿头部位置分类方面存在非常好的一致性水平（Cohen's κ = 0.89；95% CI 0.80 - 0.98）。
没有超声经验的助产士也能有效地通过超声评估胎儿头部位置及产程进展。
