Mitta Kyriaki, Tsakiridis Ioannis, Dagklis Themistoklis, Kalogiannidis Ioannis, Mamopoulos Apostolos, Michos Georgios, Virgiliou Andriana, Athanasiadis Apostolos
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
J Clin Med. 2024 Feb 13;13(4):1068. doi: 10.3390/jcm13041068.
Accurate diagnosis of labor progress is crucial for making well-informed decisions regarding timely and appropriate interventions to optimize outcomes for both the mother and the fetus. The aim of this study was to assess the progress of the second stage of labor using intrapartum ultrasound.
This was a prospective study (December 2022-December 2023) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. Maternal-fetal and labor characteristics were recorded, and two ultrasound parameters were measured: the angle of progression (AoP) and the head-perineum distance (HPD). The correlation between the two ultrasonographic values and the maternal-fetal characteristics was investigated. Multinomial regression analysis was also conducted to investigate any potential predictors of the mode of delivery.
A total of 82 women at the second stage of labor were clinically and sonographically assessed. The mean duration of the second stage of labor differed between vaginal and cesarean deliveries (65.3 vs. 160 min; -value < 0.001) and between cesarean and operative vaginal deliveries (160 vs. 88.6 min; -value = 0.015). The occiput anterior position was associated with an increased likelihood of vaginal delivery (OR: 24.167; 95% CI: 3.8-152.5; -value < 0.001). No significant differences were identified in the AoP among the three different modes of delivery (vaginal: 145.7° vs. operative vaginal: 139.9° vs. cesarean: 132.1°; -value = 0.289). The mean HPD differed significantly between vaginal and cesarean deliveries (28.6 vs. 41.4 mm; -value < 0.001) and between cesarean and operative vaginal deliveries (41.4 vs. 26.9 mm; -value = 0.002); it was correlated significantly with maternal BMI (r = 0.268; -value = 0.024) and the duration of the second stage of labor (r = 0.256; -value = 0.031). Low parity (OR: 12.024; 95% CI: 6.320-22.876; -value < 0.001) and high HPD (OR: 1.23; 95% CI: 1.05-1.43; -value = 0.007) were found to be significant predictors of cesarean delivery.
The use of intrapartum ultrasound as an adjunctive technique to the standard clinical evaluation may enhance the diagnostic approach to an abnormal labor progress and predict the need for operative vaginal or cesarean delivery.
准确诊断产程进展对于就及时且恰当的干预措施做出明智决策至关重要，这些干预措施旨在优化母婴结局。本研究的目的是使用产时超声评估第二产程的进展情况。
这是一项前瞻性研究（2022年12月至2023年12月），在希腊塞萨洛尼基亚里士多德大学健康科学学院医学院第三妇产科进行。记录母婴及分娩特征，并测量两个超声参数：进展角度（AoP）和头-会阴距离（HPD）。研究了这两个超声值与母婴特征之间的相关性。还进行了多项回归分析，以研究分娩方式的任何潜在预测因素。
共有82名处于第二产程的女性接受了临床和超声评估。第二产程的平均持续时间在阴道分娩和剖宫产之间有所不同（65.3分钟对160分钟；P值<0.001），在剖宫产和阴道助产之间也有所不同（160分钟对88.6分钟；P值=0.015）。枕前位与阴道分娩可能性增加相关（OR：24.167；95%CI：3.8 - 152.5；P值<0.001）。三种不同分娩方式的AoP未发现显著差异（阴道分娩：145.7°对阴道助产：139.9°对剖宫产：132.1°；P值=0.289）。阴道分娩和剖宫产之间的平均HPD差异显著（28.6毫米对41.4毫米；P值<0.001），剖宫产和阴道助产之间也有显著差异（41.4毫米对26.9毫米；P值=0.002）；它与孕妇BMI显著相关（r = 0.268；P值=0.024）以及第二产程持续时间显著相关（r = 0.256；P值=0.031）。低产次（OR：12.024；95%CI：6.320 - 22.876；P值<0.001）和高HPD（OR：1.23；95%CI：1.05 - 1.43；P值=0.007）被发现是剖宫产的显著预测因素。
将产时超声作为标准临床评估的辅助技术使用，可能会增强对异常产程进展的诊断方法，并预测阴道助产或剖宫产的需求。
