Engstrom J L, McFarlin B L, Sampson M B
Department of Maternal-Child Nursing, College of Nursing, University of Illinois at Chicago 60612.
J Nurse Midwifery. 1993 Nov-Dec;38(6):318-23. doi: 10.1016/0091-2182(93)90012-6.
The purpose of this study was to determine how accurately clinicians can identify the uppermost border of the uterine fundus when they obtain fundal height measurements. Clinicians were instructed to identify the uppermost border of the uterine fundus in their usual manner and make a small pen mark on the maternal abdomen at that point. Real-time ultrasonography was then used to locate the actual level of the fundus and measure the distance between the clinician's assessment and the actual level of the fundus. Measurements were obtained from 126 women. Six clinicians participated in the study, and the differences between the clinicians' errors were not statistically significant (F = 1.26; d.f. = 5,120; P = .2873). For the entire series, the mean error was -.45 cm (SD = 1.99 cm), the mean absolute error was 1.25 cm, the maximal error was 8.6 cm, the percentage of errors that exceeded 1 cm was 42.1%, and the percentage of errors that exceeded 2 cm was 20.6%. Examiner error was not associated with factors such as maternal height, prepregnancy weight, present weight, prepregnancy body mass index, parity, gestational weeks, the amount of fat on the anterior abdominal wall, or the presence of the placenta or fetal parts in the fundus. Examiner error was influenced by thickness of the uterine wall and fetal presentation. These findings indicate that clinicians make errors in identifying the uterine fundus in a significant number of cases and that the methods used by clinicians to identify the uterine fundus need to be evaluated and improved.
本研究的目的是确定临床医生在测量宫高时能够多准确地识别子宫底的最上边界。指导临床医生以他们常用的方式识别子宫底的最上边界，并在孕妇腹部的该点处做一个小的笔标记。然后使用实时超声来定位子宫底的实际水平，并测量临床医生的评估与子宫底实际水平之间的距离。对126名女性进行了测量。六名临床医生参与了该研究，临床医生之间的误差差异无统计学意义（F = 1.26；自由度= 5,120；P = 0.2873）。对于整个系列，平均误差为 -0.45 cm（标准差 = 1.99 cm），平均绝对误差为1.25 cm，最大误差为8.6 cm，超过1 cm的误差百分比为42.1%，超过2 cm的误差百分比为20.6%。检查者误差与孕妇身高、孕前体重、当前体重、孕前体重指数、产次、孕周、前腹壁脂肪量或子宫底是否存在胎盘或胎儿部分等因素无关。检查者误差受子宫壁厚度和胎儿先露的影响。这些发现表明，临床医生在大量病例中识别子宫底时会出现误差，并且临床医生用于识别子宫底的方法需要进行评估和改进。
