■本研究调查了妊娠37周时的孕妇在第二产程和产后6周的提提肌损伤进展中,提提肌裂孔直径(LHS)与胎儿头围(HC)之比的预测价值。
■在2021年3月至2022年3月期间,我们选择了120名在怀孕37周时首次阴道分娩的妇女作为受试者。将受试者分为第二产程>1h组和第二产程≤1h组,根据第二产程的分娩时间。根据产后6周随访超声检查有无肛提提肌损伤,分为肛提肌损伤组和无损伤组。所有初产妇在妊娠37周时接受了三维超声检查,和休息的LHS,ValsalvaLHS,比较胎儿HC以及静息LHS和胎儿HC的比率。采用Pearson相关分析法对这些因素与第二产程长度的相关性进行分析。通过受试者工作特征(ROC)曲线评估这些因素在预测产程进展和产后肛提肌损伤中的价值。
■休息的LHS,肛提肌损伤组的ValsalvaLHS和静息LHS和胎儿HC的比率低于无损伤组,肛提肌损伤组胎儿HC高于无损伤组(P<0.05)。休息的LHS,第二产程>1h组的ValsalvaLHS和静息LHS和胎儿HC的比率低于第二产程≤1h组。第二产程>1h组的胎儿HC高于第二产程≤1h组(P<0.05)。静息LHS/HC与总产程呈显著负相关(=-0.333,P<0.01)。ROC曲线分析显示静息LHS的AUC,ValsalvaLHS,HC,预测第二产程延长的静息LHS/HC比值分别为0.741、0.740、0.702和0.843。此外,休息LHS的AUC,ValsalvaLHS,HC,预测总产程的LHS/HC比值分别为0.657、0.684、0.768和0.836。休息LHS的AUC,ValsalvaLHS,HC,预测产后肛提肌损伤的静息LHS/HC比值分别为0.769、0.773、0.747和0.885。这些结果表明,静息LHS和胎儿HC的比值可能在预测孕妇肛提肌损伤方面具有一定的临床价值。
■LHS,胎儿HC以及静息LHS和胎儿HC的比率与产程进展和产后提肛肌损伤显着相关,对预测产程进展和产后肛提肌损伤具有一定的价值。其中,静息LHS和胎儿HC的比值具有最高的预测价值,早期检测静息LHS和胎儿HC的比例有助于指导选择合适的分娩方式。
UNASSIGNED: This study investigated the predicting
value of the ratio of levator hiatus diameter (LHS) to fetal head circumference (HC) in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum.
UNASSIGNED: A total of 120 first-time women who gave vaginal delivery at 37 weeks of pregnancy were selected as the subjects in our hospital during March 2021 to March 2022. The subjects were divided into the second stage of labor > 1 h group and the second stage of labor ≤ 1 h group, according to the delivery time of the second stage of labor. According to the 6-week postpartum follow-up ultrasound examination with or without levator ani injury, they were divided into levator ani injury group and no injury group. All primipara women underwent three-dimensional ultrasonography at 37 weeks of gestation, and the resting LHS, Valsalva LHS, fetal HC and the ratio of resting LHS and fetal HC were compared. The correlation between these factors and the length of the second labor stage was analyzed using Pearson correlation analysis. The
value of these factors in predicting labor progression and postpartum levator ani injury was assessed by receiver operating characteristic (ROC) curves.
UNASSIGNED: The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the levator ani injury group were lower than these in the no injury group, while fetal HC in the levator ani injury group was higher than that in the no injury group (P < 0.05). The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the second stage of labor > 1 h group were lower than these in the second stage of labor ≤ 1 h group, while fetal HC in the second stage of labor > 1 h group was higher than that in the second stage of labor ≤ 1 h group (P < 0.05). A significant negative correlation was observed between resting LHS/HC and total labor process (=-0.333, P < 0.01). ROC curve analysis showed that the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting prolongation of the second stage of labor were 0.741, 0.740, 0.702, and 0.843 respectively. Besides, the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting the total labor process were 0.657, 0.684, 0.768, and 0.836 respectively. The AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting postpartum levator ani muscle injury were 0.769, 0.773, 0.747, and 0.885 respectively.These results suggested that the ratio of resting LHS and fetal HC may have certain clinical
value in predicting levator ani injury in pregnant women.
UNASSIGNED: LHS, fetal HC and the ratio of resting LHS and fetal HC are significantly correlated with labor progression and postpartum levator ani injury, which have certain
value in predicting labor progress and postpartum levator ani injury. Therein, the ratio of resting LHS and fetal HC has the highest predictive
value, and early detection of the ratio of resting LHS and fetal HC is helpful to guide the selection of appropriate delivery mode.