第一产程活跃期经会阴超声对初产妇分娩方式的预测价值

  目的  探讨第一产程活跃期时产程进展角（angle of progression，AOP）、胎头下降距离（progression distance，PD）、胎头至耻骨联合距离（head-symphysis distance，HSD）等产程进展参数对分娩方式的预测价值。  方法  选取2020年7月到2021年12月在云南省第一人民医院产科经阴道试产的初产妇作为研究对象，在第一产程活跃期测量其AOP、PD、HSD，比较阴道分娩组与剖宫组之间上述参数的差异，应用ROC曲线分析各产程进展参数对孕妇分娩方式的预测价值。  结果  阴道分娩组孕妇在第一产程活跃期AOP及PD明显大于剖宫产组，（141.09±9.87）° vs （122.84±10.70）°]、（4.28±0.48） cm vs （3.18±0.83） cm]，而HSD阴道分娩组则明显小于剖宫产组（1.42±0.40） cm vs（ 2.18±0.64） cm]，差异均有统计学意义（P < 0.001）；ROC曲线分析显示，AOP、PD、HSD预测阴道分娩的曲线下面积分别为0.892、0.875、0.840，差异均有统计学意义（P < 0.001）。  结论  对经阴道试产初产妇，第1产程活跃期AOP、PD及HSD的测量对分娩方式具有预测价值。

Prediction of Delivery Mode by Transperineal Ultrasound during the Active Phase of the First Stage Labor

  Objective  To investigate the value of angle of progression progression （AOP）, fetal head descent distance （PD） and fetal head to pubic symphysis （HSD） in predicting the mode of delivery during the active phase of the first stage of labor.   Methods  The AOP, PD and HSD were measured at the active phase of the first stage of labor. The difference of these parameters was compared between the vaginal delivery group and the cesarean section group.   Results  The AOP and PD in vaginal delivery group were significantly higher than those in cesarean delivery group （141.09° ±9.87° vs 122.84° ±10.70° , 4.28 cm ± 0.48 cm vs 3.18 cm ± 0.83 cm）, while HSD in vaginal delivery group were significantly lower than that in cesarean delivery group （1.42 cm ± 0.40 cm vs 2.18 cm ± 0.64 cm） （P < 0.001）. The AUC of AOP, PD and HSD for predicting vaginal delivery was 0.892, 0.875 and 0.840, respectively, with statistical significance （P < 0.001）.   Conclusion  The measurement of AOP, PD and HSD in the active phase of the first stage of labor has the predictive value for the mode of delivery in nulliparous women.