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基于产时超声评估的产钳助产分娩临床特征分析
Analysis of the clinical characteristics of forceps-assisted delivery based on intrapartum ultrasound assessment
目的 探讨产钳助产分娩孕妇在第二产程初始阶段产时超声指标的特点。方法 基于2023年3月至2023年8月在首都医科大学附属北京妇产医院产房分娩的足月单胎孕妇队列，采用回顾性巢式病例对照研究设计，选取经产钳助产分娩的86例孕妇作为研究对象（产钳分娩组），按照1∶2比例选取同期经阴道自然分娩的172例孕妇作为对照组（自然分娩组）。比较两组孕妇的产时临床特点及产时超声指标[胎方位、产程进展角（AOP）、胎头与母体会阴间距离（HPD）]的差异。采用 t 检验、χ2检验及双变量相关分析进行数据分析。结果 （1）与自然分娩组相比，产钳分娩组HPD[（32.44±10.04）mm vs.（27.42±7.89）mm ]、第二产程时间[（79.00±52.30）min vs.（61.11±33.12）min]、非枕前胎方位比例（20.93 % vs. 5.23%）均显著增加（P<0.05），而AOP[（138.25±14.50）°vs.（143.89±15.75）°]显著降低（P<0.05）。（2） AOP与HPD两者呈显著的负相关（Pearson相关系数r=-0.530，P<0.01）。AOP与胎先露位置呈正相关（r=0.376，P<0.01），AOP=143.44°相当于胎先露S=+2；HPD与胎先露位置呈负相关（r=-0.485，P<0.01），与第二产程时间呈正相关（r=0.132，P<0.05），HPD=28.39 mm相当于胎先露S=+2。结论 产时超声AOP和HPD指标可反映胎先露位置，从而辅助决策产钳助产分娩和产程管理。
Objective To explore the characteristics of intrapartum ultrasound indicators in the initial stage of the second stage of labor in pregnant women with forceps-assisted delivery. Methods Base on a cohort of full-term singleton pregnant women who delivered in the maternity ward of Beijing Obstetrics and Gynecology Hospital，Capital Medical University， from March 2023 to August 2023. A retrospective，nested case-control study design was adopted，and 86 pregnant women who had forceps-assisted viginal delivery were included as research subjects（forceps delivery group）.Another 172 pregnant women who had spontaneous vaginal delivery during the same period were randomly selected as the control group（natural delivery group） at a ratio of 1∶2.The differences in intrapartum clinical characteristics and intrapartum ultrasound indicators （fetal position，AOP，HPD）between the two groups were compared. The data were analyzed using t-tests，χ2 tests，and bivariate correlation analysis. Results （1） Compared with the natural delivery group，the HPD [（32.44±10.04）mm vs. （27.42±7.89）mm]，the time of second stage of labor[（79.00±52.30）min vs. （61.10±33.12）min]，and the proportion of non-occipitoanterior fetal positions （20.93% vs. 5.23%） in the forceps delivery group all significantly increased（P<0.05），while the AOP[（138.25±14.50）° vs. （143.89±15.75）°] significantly decreased （P<0.05）. （2）There was a significant negative correlation between AOP and HPD，with the Pearson correlation coefficient r=-0.530 （P<0.01）.AOP was positively correlated with the fetal presenting part（r=0.376，P<0.01），and AOP = 143.44°was equivalent to the fetal presenting part at S=+2；HPD was negatively correlated with the fetal presenting part （r=-0.485，P<0.01） and positively correlated with the time of second stage of labor（r=0.132，P<0.05），and HPD=28.39 mm was equivalent to the fetal presenting part at S=+2. Conclusion Intrapartum ultrasound indicators AOP and HPD can reflect the position of the fetal presenting，assisting in decision-making for forceps-assisted delivery and labor management.
产时超声 / 第二产程 / 产钳助产 / 产程进展角 / 胎头会阴距离
intrapartum ultrasound / the second stage of labor / forceps-assisted delivery / angle of progression / head-perineum distance
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张培, 张媛, 王青青, 等. 产时超声指标预测胎头吸引产术的难易程度[J]. 中华围产医学杂志, 2025, 28(3):194-202. DOI:10.3760/cma.j.cn113903-20240428-00317.
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To compare the angle of progression (AoP) measured by transperineal ultrasonography before indicating an instrumental delivery or cesarean delivery.A prospective observational study was conducted among women with singleton term pregnancies with prolonged second stage of labor at Kwong Wah Hospital, Hong Kong, China, between May 16, 2011, and May 25, 2016. Transabdominal and transperineal ultrasonography were performed to determine fetal head position and AoP, respectively, both at rest and during uterine contraction with pushing. Mode of delivery was decided after vaginal examination without relying on ultrasonography.Of 143 women, 116 underwent successful instrumental delivery and 27 underwent cesarean delivery. Median AoP was 153.0° in the instrumental group versus 139.0° in the cesarean group at rest (P<0.001), and 182.5° in the instrumental group versus 156.5° in the cesarean group during contraction (P<0.001). The best predictive cutoff AoP for successful instrumental delivery was 138.7° at rest (sensitivity 86.2%, specificity 51.9%) and 160.9° during contraction (sensitivity 87.1%, specificity 74.1%). No between-group differences in AoP were found for ease of vacuum extraction at rest (P=0.457) or during contraction with pushing (P=0.095).The AoP predicted approximately 80% of successful instrumental deliveries performed for prolonged second stage of labor.© 2018 International Federation of Gynecology and Obstetrics.
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超声逐渐用于产时判断胎方位和胎头位置来评估产程进展，辅助临床进行分娩管理。文章依据临床指南和临床研究，阐述产时超声监测的参数指标及其对改善分娩结局的作用。
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The purpose of these Guidelines is to review the published techniques of ultrasound in labor and their practical applications, to summarize the level of evidence regarding the use of ultrasound in labor and to provide guidance to practitioners on when ultrasound in labor is clinically indicated and how the sonographic findings may affect labor management. We do not imply or suggest that ultrasound in labor is a necessary standard of care.Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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刘洪莉, 张兰, 漆洪波. 国际妇产科超声学会实践指南解读:产时超声[J]. 中国实用妇科与产科杂志, 2019, 35(2):206-209.DOI:10.19538/j.fk2019020118.
临床产程停滞的诊断、干预产程的时间和处理方法主要依据宫口扩张的大小与时间、阴道触诊胎头的位置及胎方位而定。但是，研究显示通过临床触诊判断胎头位置及胎方位往往比较主观且准确率不高。近年来，超声检查逐渐辅助临床进行产时管理，并起到一定作用。国际妇产科超声学会（The International Society of Ultrasound in Obstetrics and Gynecology，ISUOG）指南通过回顾关于产时超声技术的研究表明，产时超声判断胎头位置、胎方位及预测产程停滞比临床触诊客观且具有更高的准确性及可重复性，并且能够在一定程度上预测阴道分娩的结局［1］。这为医务人员提供了一个临床上产时超声何时适用及超声检查结果如何影响分娩处理的指南。浏览更多请关注本刊微信公众号及当期杂志。
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Intrapartum ultrasound (US) is more reliable than clinical assessment in determining parameters of crucial importance to optimize the management of labor including the position and station of the presenting part. Evidence from the literature supports the role of intrapartum US in predicting the outcome of labor in women diagnosed with slow progress during the first and second stage of labor, and randomized data have demonstrated that transabdominal US is far more accurate than digital examination in assessing fetal position before performing an instrumental delivery. Intrapartum US has also been shown to outperform the clinical skills in predicting the outcome and improving the technique of instrumental vaginal delivery. On this basis, some guidelines recommend intrapartum US to ascertain occiput position before performing an instrumental delivery. Manual rotation of occiput posterior position (MROP) and assisted breech delivery of the second twin are other obstetric interventions that can be performed during the second stage of labor with the support of intrapartum US. In this review article we summarize the existing evidence on the role of intrapartum US in assisting different types of obstetric intervention with the aim to improve their safety.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
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The World Health Organization in recent years has emphasized reducing the possibility of unnecessary interventions in natural childbirth, but little is known about the accuracy of non-invasive methods when assessing the progress of labor. This paper presents a literature review to assess strategies that support non-invasive methods for labor during the first stage. It evaluates the available evidence to provide the most suitable assessments and predictions that objectively identify the progress of low-risk labor during the first stage of labor.
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Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.
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尤海英, 罗漫灵, 尹爱兰, 等. 活跃期经会阴三维超声测量产程进展参数对分娩方式及分娩时长的预测价值研究[J]. 中国实用妇科与产科杂志, 2025, 41(1):110-114.DOI:10.19538/j.fk2025010124.
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