Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital/Faculty of Medicine Sriwijaya University, Palembang, South Sumatra, Indonesia.
Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital/Faculty of Medicine Sriwijaya University, Palembang, South Sumatra, Indonesia.
Med Sci Monit. 2024 Oct 9;30:e945458. doi: 10.12659/MSM.945458.
BACKGROUND Assessment of labor progress via digital vaginal examination is subjective, while intrapartum transperineal ultrasonography is deemed more objective and effective. The angle of descent (AoD) is a reliable intrapartum transperineal ultrasound parameter with minimal inter-observer and intra-observer errors. This study compared intrapartum transperineal ultrasonography with digital vaginal examination in evaluating the angle of descent for vaginal delivery selection in 70 women. MATERIAL AND METHODS This cross-sectional study was conducted at Dr. Mohammad Hoesin Hospital Palembang in Indonesia, using a consecutive sampling method to measure AoD of 70 patients at admission and every 2 h during labor progression. Patients were monitored until childbirth, and outcomes of successful vaginal or cesarean delivery were reported. A diagnostic test determined the optimal AoD for predicting successful vaginal delivery and its predictive value. RESULTS The study included 70 patients with a mean age of 28.29±6.09 years and a body mass index of 30.59±3.49 kg/m². Among them, 29 (41%) had successful vaginal deliveries. Adequate contraction frequency at admission was strongly associated with successful vaginal delivery (P<0.001). The optimal AoD for predicting successful vaginal delivery was 94.5°, with an area under the curve of 0.567 (95% CI 0.425-0.710), sensitivity of 84.2%, specificity of 45.7%, and accuracy of 54.3%. CONCLUSIONS Intrapartum transperineal ultrasonography for measuring AoD can be a valuable adjunct in labor management. Further investigations are needed to validate the optimal AoD in Indonesian pregnant women.
经阴道检查评估产程进展具有主观性，而经会阴分娩期超声检查则被认为更为客观有效。下降角度（AoD）是一种可靠的经会阴超声参数，其观察者间和观察者内误差最小。本研究比较了经会阴超声检查与经阴道检查在评估 70 例阴道分娩选择中下降角度的作用。
这是一项在印度尼西亚巨港穆罕默德·胡辛医院进行的横断面研究，采用连续抽样法测量 70 例患者入院时和产程进展每 2 小时的 AoD。患者被监测至分娩结束，报告阴道分娩或剖宫产的结局。诊断试验确定了预测阴道分娩成功的最佳 AoD 及其预测值。
本研究共纳入 70 例患者，平均年龄为 28.29±6.09 岁，体重指数为 30.59±3.49kg/m²。其中，29 例（41%）成功阴道分娩。入院时适当的宫缩频率与阴道分娩成功密切相关（P<0.001）。预测阴道分娩成功的最佳 AoD 为 94.5°，曲线下面积为 0.567（95%可信区间为 0.425-0.710），灵敏度为 84.2%，特异度为 45.7%，准确性为 54.3%。
经会阴超声测量 AoD 可作为产程管理的有用辅助手段。需要进一步研究来验证印度尼西亚孕妇的最佳 AoD。
