超声第一产程监测参数对产妇分娩方式的指导价值

doi:10.12280/gjfckx.20250633

摘要/Abstract

摘要：

目的：分析超声第一产程监测参数对产妇分娩方式的指导价值。方法：选取2024年1—12月收治的住院分娩产妇218例，均在第一产程中动态监测超声参数：胎头耻骨联合间距（head-symphysis distance，HSD）、胎头下降距离（head progression distance，HPD）、产程进展角（angle of progression，AOP）、脑中线角度（midline angle，MLA）、耻骨弓角度（pubic arch angle，PAA）。按照产妇分娩方式将其分为自然分娩组（n=166）和剖宫产组（n=52）。比较2组的一般临床资料及HSD、HPD、AOP、MLA、PAA值，采用二元Logistic回归分析影响产妇剖宫产的因素，采用受试者工作特征（receiver operating characteristic，ROC）曲线分析单一超声参数及联合预测产妇分娩方式的预测效能。结果：HSD、HPD是剖宫产的危险因素，而AOP、MLA、PAA增大是剖宫产的保护因素，差异有统计学意义（P<0.05）。HSD、HPD、AOP、MLA、PAA及5项指标联合预测的曲线下面积（area under curve，AUC）值分别为0.803、0.737、0.905、0.778、0.737和0.967，敏感度分别为0.673、0.846、0.819、0.654、0.645和0.923，特异度分别为0.855、0.536、0.865、0.885、0.731和0.898，联合的AUC高于单个指标，具有良好的特异度和敏感度，差异有统计学意义（P<0.05）。结论：超声第一产程监测的HSD、HPD、AOP、MLA、PAA对判断产妇分娩方式具有重要指导意义，5项参数联合预测的效能优于单一参数。

关键词: 超声检查, 产程，第一, 分娩, 妊娠结局, Logistic模型

Abstract:

Objective: To analyze the guiding value of ultrasonic monitoring parameters in the first stage of labor for maternal delivery modes. Methods: A total of 218 hospitalized parturients admitted from January to December 2024 were selected. Ultrasonic parameters were dynamically monitored during the first stage of labor, including head-symphysis distance (HSD), head progression distance (HPD), angle of progression (AOP), midline angle (MLA), and pubic arch angle (PAA). The parturients were divided into a spontaneous delivery group (n=166) and a cesarean section group (n=52), according to their delivery modes. The general clinical data and the values of HSD, HPD, AOP, MLA and PAA were compared between the two groups. Binary logistic regression was used to analyze the factors influencing cesarean section in parturients. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of single ultrasonic parameters and their combination in predicting maternal delivery modes. Results: Increased HSD and HPD were risk factors for cesarean section, while increased AOP, MLA, and PAA were protective factors for cesarean section, with statistically significant differences (P<0.05). The area under the curve (AUC) values of HSD, HPD, AOP, MLA, PAA, and the combination of the five indicators were 0.803, 0.737, 0.905, 0.778, 0.737, and 0.967 respectively; the sensitivities were 0.673, 0.846, 0.819, 0.654, 0.645, and 0.923 respectively; the specificities were 0.855, 0.536, 0.865, 0.885, 0.731, and 0.898 respectively. The AUC of the combination was higher than that of single indicators, with good specificity and sensitivity, and the difference was statistically significant (P<0.05). Conclusions: HSD, HPD, AOP, MLA, and PAA monitored by ultrasound in the first stage of labor have important guiding significance for judging maternal delivery modes. The predictive efficacy of the combination of the five parameters is better than that of single parameters.

Key words: Ultrasonography, Labor stage, first, Parturition, Pregnancy outcome, Logistic models

金华, 任郁, 赵静. 超声第一产程监测参数对产妇分娩方式的指导价值[J]. 国际妇产科学杂志, 2025, 52(6): 668-671.

JIN Hua, REN Yu, ZHAO Jing. The Guiding Value of Ultrasonic Monitoring Parameters in the First Stage of Labor for Maternal Delivery Modes[J]. Journal of International Obstetrics and Gynecology, 2025, 52(6): 668-671.

图/表 5

参考文献 16

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组别	n	年龄（岁）	入院BMI（kg/m²）	孕周（周）	新生儿出生体质量（g）	是否无痛分娩（是/否）
剖宫产组	52	26.31±2.55	28.42±1.31	39.06±2.82	3 372.08±243.08	20/32
自然分娩组	166	26.77±2.32	28.54±1.22	38.80±2.86	3 381.07±251.99	60/106
t或χ²		-1.212	-0.589	0.579	-0.226	0.092
P		0.227	0.556	0.563	0.821	0.762

组别	n	年龄（岁）	入院BMI（kg/m²）	孕周（周）	新生儿出生体质量（g）	是否无痛分娩（是/否）
剖宫产组	52	26.31±2.55	28.42±1.31	39.06±2.82	3 372.08±243.08	20/32
自然分娩组	166	26.77±2.32	28.54±1.22	38.80±2.86	3 381.07±251.99	60/106
t或χ²		-1.212	-0.589	0.579	-0.226	0.092
P		0.227	0.556	0.563	0.821	0.762

组别	n	HSD（cm）	HPD（cm）	AOP（°）	MLA（°）	PAA（°）
剖宫产组	52	1.92±0.47	4.97±0.55	120.95±9.41	73.14±3.18	91.74±7.18
自然分娩组	166	1.39±0.43	4.50±0.47	139.03±10.55	76.63±3.03	98.72±8.39
t		7.661	6.080	-11.050	-7.158	-5.405
P		<0.001	<0.001	<0.001	<0.001	<0.001

组别	n	HSD（cm）	HPD（cm）	AOP（°）	MLA（°）	PAA（°）
剖宫产组	52	1.92±0.47	4.97±0.55	120.95±9.41	73.14±3.18	91.74±7.18
自然分娩组	166	1.39±0.43	4.50±0.47	139.03±10.55	76.63±3.03	98.72±8.39
t		7.661	6.080	-11.050	-7.158	-5.405
P		<0.001	<0.001	<0.001	<0.001	<0.001

变量	B	SE	Wald χ²	P	OR（95%CI）
HSD（cm）	2.253	0.752	8.974	0.003	9.512（2.179~41.529）
HPD（cm）	2.547	0.740	11.854	0.001	12.769（2.995~54.434）
AOP（°）	-0.194	0.040	23.485	<0.001	0.824（0.761~0.891）
MLA（°）	-0.243	0.093	6.751	0.009	0.785（0.653~0.942）
PAA（°）	-0.154	0.045	11.742	0.001	0.858（0.786~0.936）