Abstract：
OBJECTIVE: To evaluate the level of agreement between ultrasound measurements to evaluate fetal head position and progress of labor by attending midwives and obstetricians after appropriate training.
METHODS: In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head-to-perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position.
RESULTS: We found a good correlation between the AoP measured by obstetricians and midwives (intra-class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80-0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68-0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91-0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen\'s κ = 0.89; 95% CI 0.80-0.98).
CONCLUSIONS: Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.
METHODS: In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head-to-perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position.
RESULTS: We found a good correlation between the AoP measured by obstetricians and midwives (intra-class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80-0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68-0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91-0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen\'s κ = 0.89; 95% CI 0.80-0.98).
CONCLUSIONS: Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.
摘要：
目的：通过接受适当培训后参加助产士和产科医生，评估超声测量值之间的一致性水平，以评估胎儿头部位置和分娩过程。
方法：在这项前瞻性研究中，2018年3月至2019年12月期间,在我们的产科病房,在产程第一阶段分娩一名头颅显示的婴儿的妇女被邀请参加;109名妇女同意.经会阴和经腹超声由训练有素的助产士和产科医生独立进行。在107例病例中，有两个成对的测量可用于比较进展角度（AoP），在头到会阴距离（HPD）的106例中，在97例宫颈扩张（CD）中，79例胎儿头部位置。
结果：我们发现产科医生和助产士测量的AoP之间存在良好的相关性（组内相关系数[ICC]=0.85；95%置信区间[CI]0.80-0.89）。HPD之间存在中度相关性（ICC=0.75；95%CI0.68-0.82）。测量的CD之间存在非常好的相关性(ICC=0.94;95%CI0.91-0.96)。胎头位置的分类具有很好的一致性（Cohenκ=0.89；95％CI0.80-0.98）。
结论：在没有超声检查经验的情况下，参加助产士可以有效地评估胎儿头位和产程。
方法：在这项前瞻性研究中，2018年3月至2019年12月期间,在我们的产科病房,在产程第一阶段分娩一名头颅显示的婴儿的妇女被邀请参加;109名妇女同意.经会阴和经腹超声由训练有素的助产士和产科医生独立进行。在107例病例中，有两个成对的测量可用于比较进展角度（AoP），在头到会阴距离（HPD）的106例中，在97例宫颈扩张（CD）中，79例胎儿头部位置。
结果：我们发现产科医生和助产士测量的AoP之间存在良好的相关性（组内相关系数[ICC]=0.85；95%置信区间[CI]0.80-0.89）。HPD之间存在中度相关性（ICC=0.75；95%CI0.68-0.82）。测量的CD之间存在非常好的相关性(ICC=0.94;95%CI0.91-0.96)。胎头位置的分类具有很好的一致性（Cohenκ=0.89；95％CI0.80-0.98）。
结论：在没有超声检查经验的情况下，参加助产士可以有效地评估胎儿头位和产程。
