目的:评估产程进展的完善的临床实践包括常规腹部触诊和阴道检查(VE)。然而,VE是主观的,可重复性差,女性痛苦。在这项研究中,我们的目的是评估系统地整合经腹和经会阴超声评估胎儿位置的可行性,psAOP,HPD和SCD监测引产(IOL)妇女的分娩进展。我们还旨在确定超声检查是否可以减轻女性在检查期间的疼痛。
方法:在三个产妇单元中招募妇女进行IOL检查。对100名妊娠37+0至41+6周的女性进行超声评估。进行基线经腹和经会阴联合扫描,包括胎儿生物测定的评估,脐动脉和大脑中动脉多普勒,羊水指数(AFI),胎儿脊柱和枕骨位置,psAOP,火警局,SCD,和宫颈长度。根据方案进行产时扫描而不是VE。参与者被要求在评估期间通过口头给出0-10的疼痛评分(0表示没有疼痛)来表明他们的疼痛水平。通过混合效应模型对重复测量数据进行分析,以确定影响psAOP之间关系的重要因素,火警局,SCD和交付方式。
结果:223次产时超声扫描,每位参与者的中位数为2次(四分位距(IQR)=1-3),进行了151次评估,每位参与者的中位数为1次(IQR=0-2)。没有不良的胎儿或母体结局。在排除检查期间硬膜外麻醉的患者后,产时扫描的中位疼痛评分为0(IQR=0-1),VE的中位疼痛评分为3(IQR=0-6).剖宫产和硬膜外麻醉与psAOP变化速率较慢显著相关,HPD和SCD。产妇身高,产次和新生儿出生体重不影响超声测量产程进展.
结论:全面的经腹和经会阴超声评估可以成功地用于评估产程进展,并可以减轻检查过程中的疼痛程度。超声评估可能能够替代分娩期间的一些经腹和VE检查。本文受版权保护。保留所有权利。
OBJECTIVE: Well-established clinical practice for assessing progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for most women. In this study, our aim was to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, parasagittal angle of progression (psAOP), head-perineum distance (HPD) and sonographic cervical dilatation (SCD) to monitor the progress of labor in women undergoing induction of labor (IOL). We also aimed to determine if ultrasound can reduce women\'s pain during such examinations.
METHODS: Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37 + 0 and 41 + 6 weeks\' gestation. A baseline combined transabdominal and transperineal scan was performed, including assessment of fetal biometry, umbilical artery and fetal middle cerebral artery Doppler, amniotic fluid index, fetal spine and occiput positions, psAOP, HPD, SCD and cervical length. Intrapartum scans were performed instead of VE, unless there was a clinical indication to perform a VE, according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score between 0 and 10 (with 0 representing no pain) during assessment. Repeated measures data were analyzed using mixed-effect models to identify significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery.
RESULTS: A total of 100 women were included in the study. Of these, 20% delivered by Cesarean section, 65% vaginally and 15% by instrumental delivery. There were no adverse fetal or maternal outcomes. A total of 223 intrapartum ultrasound scans were performed in 87 participants (13 women delivered before intrapartum ultrasound was performed), with a median of two scans per participant (interquartile range (IQR), 1-3). Of these, 76 women underwent a total of 151 VEs with a median of one VE per participant (IQR, 0-2), with no significant difference between vaginal- or Cesarean-delivery groups. After excluding those with epidural anesthesia during examination, the median pain score for intrapartum scans was 0 (IQR, 0-1) and for VE it was 3 (IQR, 0-6). Cesarean delivery was significantly associated with a slower rate of change in psAOP, HPD and SCD.
CONCLUSIONS: Comprehensive transabdominal and transperineal ultrasound assessment can be used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and vaginal examinations during labor. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.