Mitta Kyriaki, Tsakiridis Ioannis, Virgiliou Andriana, Mamopoulos Apostolos, Capros Hristiana, Athanasiadis Apostolos, Dagklis Themistoklis
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
Department of Obstetrics and Gynecology, Nicolae Testemitsanu State University of Medicine and Pharmacy Chisinau, MD-2004 Chișinău, Moldova.
J Clin Med. 2025 Jul 25;14(15):5283. doi: 10.3390/jcm14155283.
Recent changes in obstetric practices and population demographics have prompted a re-evaluation of labor patterns. This study aimed to characterize labor patterns in a Greek pregnant population using ultrasound and compare them with established labor curves. A prospective cohort study was conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, over a two-year period (December 2022 to June 2024). Transabdominal ultrasound was used to determine the fetal head position and transperineal ultrasound was used to measure angle of progression (AoP) and head-perineum distance (HPD) during labor. Maternal and labor characteristics, including body mass index (BMI), parity, labor duration, and mode of delivery, were recorded. Statistical analysis included mixed linear models to assess the relationship between AoP, HPD, and cervical dilatation. In total, 500 parturients were included in this study. Women entered the active phase of labor approximately 5 h before delivery, with AoP increasing sharply and HPD decreasing rapidly at this point. Cesarean section (CS) cases showed a slower increase in AoP compared to vaginal deliveries (VDs), with CS cases having a mean AoP of 117.9° (95% CI: 111.6-124.2°) at full dilation, compared to 133.4° (95% CI: 130.6-136.2°) in VD. HPD values declined more slowly in CS cases, with a mean HPD of 45.1 mm (95% CI: 40.6-49.6 mm) at full dilation, compared to 36.4 mm (95% CI: 34.3-38.5 mm) in VD. Epidural analgesia was associated with steeper increases in AoP and decreases in HPD in the final 2.5 h before delivery, while oxytocin administration accelerated these changes in the last 3-4 h. The mean time to delivery was 3.19 h (95% CI: 2.80-3.59 h) when AoP reached 125° and 3.92 h when HPD was 40 mm (95% CI: 3.53-4.30 h). BMI in women who gave birth via CS was significantly higher compared to VD (32.03 vs. 29.94 kg/m, -value: 0.008), and the total duration of labor was shorter in VD compared to CS and operative vaginal delivery (OVD) (8 h vs. 15 h, -value < 0.001 and 8 h vs. 12 h, -value < 0.001, respectively). Birthweight was also lower in VD compared to CS (3103.09 g vs. 3267.88 g, -value: 0.05). This study provides the first ultrasonographic characterization of labor patterns in a Greek population, highlighting the utility of ultrasound in objectively assessing labor progression.
近期产科实践和人口统计学的变化促使人们重新评估分娩模式。本研究旨在利用超声对希腊孕妇群体的分娩模式进行特征描述，并将其与既定的分娩曲线进行比较。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了一项为期两年（2022年12月至2024年6月）的前瞻性队列研究。经腹超声用于确定胎儿头部位置，经会阴超声用于测量分娩期间的进展角度（AoP）和头部与会阴距离（HPD）。记录产妇和分娩特征，包括体重指数（BMI）、产次、分娩持续时间和分娩方式。统计分析包括混合线性模型，以评估AoP、HPD和宫颈扩张之间的关系。本研究共纳入500名产妇。女性在分娩前约5小时进入活跃期，此时AoP急剧增加，HPD迅速下降。与阴道分娩（VD）相比，剖宫产（CS）病例的AoP增加较慢，CS病例在完全扩张时的平均AoP为117.9°（95%CI：111.6 - 124.2°），而VD为133.4°（95%CI：130.6 - 136.2°）。CS病例的HPD值下降更慢，完全扩张时的平均HPD为45.1mm（95%CI：40.6 - 49.6mm），而VD为36.4mm（95%CI：34.3 - 38.5mm）。硬膜外镇痛与分娩前最后2.5小时内AoP的急剧增加和HPD的下降有关，而催产素给药在最后3 - 4小时加速了这些变化。当AoP达到125°时，平均分娩时间为3.19小时（95%CI：2.80 - 3.59小时），当HPD为40mm时，平均分娩时间为3.92小时（95%CI：3.53 - 4.30小时）。与VD相比，CS分娩女性的BMI显著更高（32.03 vs. 29.94kg/m²，P值：0.008），VD的总分娩持续时间比CS和阴道助产（OVD）短（8小时vs. 15小时，P值<0.001和8小时vs. 12小时，P值<0.001）。与CS相比，VD的出生体重也更低（3103.09g vs. 3267.88g，P值：0.05）。本研究首次对希腊人群的分娩模式进行了超声特征描述，突出了超声在客观评估分娩进展方面的实用性。
