Pregazzi R, Troiano L, Licitra L, De Seta F, Scrimin F, Guaschino S
Università degli Studi, Trieste Clinica Ostetrica e Ginecologica Istituto Scientifico Burlo Garofolo.
Minerva Ginecol. 1998 Jun;50(6):221-4.
According to some authors, vaginal delivery always causes denervation of perineum and the greater the damage the longer the second labour phase (the so-called "delivering phase"). Therefore, it is necessary to reduce the number of too prolonged labours, but it is equally important to avoid an uncontrolled increase of cesarean sections. In order to achieve this objective, it is important to carry out a careful selection among laboring women and choose those most at risk for whom cesarean section is strongly recommended. On the basis of the data collected by the medical literature and in consideration of the pathogenetic role of the outlet dystocia, we have tried to identify a simple and effective prognostic index resulting from the different pelvimetric and ultrasonographic parameters.
In 72 full-term pregnant women, we have taken into account the ultrasonographic parameters expressing the fetal dimension (cephalic diameters, cephalic and abdominal circumferences, estimated fetal weight according to Haddlok), the outlet pelvic diameters (trans-ischial and coccygeal-pubic) and a fetal-pelvic index derived from these parameters.
If taken individually, these parameters do not seem to have any direct connection with the length of the delivering phase, but the combination of the cephalic and external pelvimetric diameters has produced a significative statistical coefficient.
On the basis of the data collected, it is suggested that a careful evaluation of external pelvimetric and cephalic parameters would be useful from the clinical point of view.
一些作者认为，阴道分娩总会导致会阴神经损伤，损伤越严重，第二产程（即所谓的“分娩期”）持续时间越长。因此，有必要减少过长产程的数量，但同样重要的是要避免剖宫产率不受控制地增加。为了实现这一目标，对分娩妇女进行仔细筛选并选择那些剖宫产强烈推荐的高危人群非常重要。根据医学文献收集的数据，并考虑到出口难产的发病机制作用，我们试图从不同的骨盆测量和超声参数中确定一个简单有效的预后指标。
在72名足月孕妇中，我们考虑了表示胎儿大小的超声参数（头径、头围和腹围、根据哈洛克公式估算的胎儿体重）、出口骨盆直径（坐骨间径和尾耻径）以及从这些参数得出的胎儿-骨盆指数。
单独来看，这些参数似乎与分娩期长度没有任何直接关联，但头径和骨盆外测量直径的组合产生了一个有统计学意义的系数。
根据收集到的数据，建议从临床角度仔细评估骨盆外测量和头径参数会很有用。
