头部伸展引导会阴手动辅助的出生与调节（BREGMA）研究：一项前瞻性队列研究。
Birth and Regulation of head Extension to Guide Manual perineal Assistance (BREGMA) study: a prospective cohort study.
作者信息
Abouelhassan Abdelrahman, Kalis Vladimir, Schüssler Marc, Awwad Hassan, Ahmed Rania H M, Ismail Khaled M
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo, 1181, Egypt.
Department of Obstetrics & Gynecology, Agaplesion General Hospital Hagen (Allgemeines Krankenhaus Hagen), Hagen, Germany.
出版信息
BMC Pregnancy Childbirth. 2025 Mar 21;25(1):334. doi: 10.1186/s12884-025-07428-z.
BACKGROUND
The exact positioning of the dominant hand at the time of manual perineal protection (MPP) is not clearly specified. The main aim of this work was to identify the place on the perineum where pressure needs to be applied to achieve optimal forward fetal head displacement away from the anal sphincters using the bregma to posterior fourchette distance (BFD) and the perineal body length (PBL).
METHODS
This was a two-center prospective cohort study. Term cephalic singleton nulliparous women having spontaneous vaginal delivery were considered eligible for recruitment into the study. Once crowning was diagnosed and just prior the initiation of manual perineal protection (MPP) or cutting an episiotomy, the BFD and PBL were measured using a standardized measurement protocol.
RESULTS AND DISCUSSION
A total of 100 women (50 women in each center) were recruited into the study. The overall mean BFD was 2.8 ± 0.5 cm. The overall mean PBL was 4.4 ± 0.8 cm. There were no statistically significant differences between the measurements taken in both units regarding BFD or PBL (p = 0.81 and 0.10 respectively). There was a weak correlation between both measurements. Based on our measured parameters, it seems that the most effective point to apply perineal pressure to displace the head away from the anus is approximately 1 - 1.5 cm anterior to the anal margin.
CONCLUSION
Measurements generated by this study will form the bases of future biomechanical studies to confirm their validity.
背景
在进行手法会阴保护（MPP）时，优势手的确切位置并未明确规定。本研究的主要目的是利用前囟至后阴唇系带距离（BFD）和会阴体长度（PBL），确定在会阴上施加压力的位置，以实现胎儿头部最佳向前移位，远离肛门括约肌。
方法
这是一项双中心前瞻性队列研究。足月头位单胎初产妇且自然阴道分娩者被认为符合纳入本研究的条件。一旦诊断出头冠显露，且恰好在开始手法会阴保护（MPP）或切开会阴之前，使用标准化测量方案测量BFD和PBL。
结果与讨论
共有100名女性（每个中心50名）被纳入本研究。总体平均BFD为2.8±0.5厘米。总体平均PBL为4.4±0.8厘米。两个单位在BFD或PBL测量方面无统计学显著差异（分别为p = 0.81和0.10）。两项测量之间存在弱相关性。根据我们测量的参数，似乎在距肛门边缘前方约1 - 1.5厘米处施加会阴压力以使头部远离肛门是最有效的点。
结论
本研究产生的测量结果将成为未来生物力学研究以确认其有效性的基础。
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