经会阴超声测量 AOP 和 HPD 与初产妇分娩方式的关联：一项单中心前瞻性队列研究

丽丽 徐(温州医科大学附属东阳医院，中国)
江锋 吴(温州医科大学附属东阳医院，中国)
舜兰 杜(温州医科大学附属东阳医院，中国)

摘要

目的：鉴于全球剖宫产率持续上升，特别是中国高达36.7%，本研究旨在评估经会阴超声测量的胎头下降进展角（AOP）和胎头会阴距离（HPD）对初产妇分娩方式的预测价值。方法：这项前瞻性队列研究于2022年1月至2024年1月在温州医科大学附属东阳医院开展，纳入98例足月单胎初产妇。在产程开始时和宫口开全时测量AOP和HPD，采用双盲法记录分娩方式。结果：产程开始时的HPD（截断值3.835cm）显示最高预测准确性（AUC=0.898，95%CI：0.759~0.955），其次为产程开始时的AOP（截断值111.66°，AUC=0.888，95%CI：0.731~0.978）。决策曲线分析显示HPD1在中等风险阈值区间（0.2~0.6）维持最稳定的净收益（0.70~0.75）。结论：产程早期的HPD和AOP测量可靠预测分娩方式，为临床决策提供客观依据。

关键词

经会阴超声；胎头下降进展角；分娩方式；初产妇

参考

BETRAN A P, YE J, MOLLER A B, et al. Trends and projections of caesarean section rates: global and regional estimates [J]. BMJ Glob Health, 2021, 6(6).

DOWNE S, GYTE G M, DAHLEN H G, et al. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term [J]. Cochrane Database Syst Rev, 2013, (7): Cd010088.

AHN K H, OH M J. Intrapartum ultrasound: A useful method for evaluating labor progress and predicting operative vaginal delivery [J]. Obstet Gynecol Sci, 2014, 57(6): 427-35.

GHI T, EGGEBØ T, LEES C, et al. ISUOG Practice Guidelines: intrapartum ultrasound [J]. Ultrasound Obstet Gynecol, 2018, 52(1): 128-39.

JUNG J E, LEE Y J. Intrapartum transperineal ultrasound: angle of progression to evaluate and predict the mode of delivery and labor progression [J]. Obstet Gynecol Sci, 2024, 67(1): 1-16.

KAHRS B H, EGGEBØ T M. Intrapartum ultrasound in women with prolonged first stage of labor [J]. Am J Obstet Gynecol MFM, 2021, 3(6s): 100427.

刘春花,向雪雯,温凤云,等.经会阴超声测量第一产程进展参数对分娩方式及母婴结局的影响[J].中国妇产科临床杂志,2024,25(1):82-83.

ALI J, HEBBAR S. Ultrasound Assessment of Foetal Head-Perineum Distance Prior to Induction of Labour as a Predictor of Successful Vaginal Delivery [J]. J Obstet Gynaecol India, 2019, 69(2): 129-135.

SFAKIANOUDIS K, MAZIOTIS E, GRIGORIADIS S, et al. Reporting on the Value of Artificial Intelligence in Predicting the Optimal Embryo for Transfer: A Systematic Review including Data Synthesis [J]. Biomedicines, 2022, 10(3).

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v7i12.22859