胎方位异常阴道分娩第二产程会阴超声测量产程进展参数的临床研究OACSTPCD

Objective:To study and evaluate the effectiveness of intrapartum transperi-neal ultrasound monitoring the progress of labor parameters in evaluating the management of non-occipital-anterior vaginal delivery and the model of clinical application.Methods:From June 2021 to June 2023,we collected 48 cases of full-term pregnant women with non-occipital-anterior vaginal trial delivery who were admitted to Suzhou Hospital Affiliated to Nanjing Medi-cal University.According to the mode of delivery,there were 35 cases in vaginal delivery group and 13 cases in cesarean section group.During the labor process,intrapartum transperineal ul-trasound was used to measure the angle of progression(AOP)and midline angle(MA)at dif-ferent time points in the second stage of labor to evaluate the progress of labor in Group A and Group B.The statistical differences between the two groups in the angle of labor progress and the midline angle was compared.Logistic regression analysis and receiver operating characteris-tic analysis were used to calculate the cut-off value of relevant risk factors.Results:The average AOP of vaginal delivery group and cesarean section group were(127.5±4.5)degrees and(107.5±6.6)degrees respectively,when the cervical orifice was fully opened at the initial of the second stage of labor.The average AOP of group A and group B were(135.3±3.9)de-grees and(114.0±7.8)degrees respectively after the fully opening of the cervical orifice for1 hour.The average value of AOP in group A and group B was(157.7±5.6)and(125.3±5.3)degrees at 2 hours after the fully opening of the cervical orifice.In the second stage of labor,the average values of MA in group A and group B were(112.7±18.7)degrees and(137.2±19.5)degrees respectively.The average MA values of group A and group B were(73.9±18.0)degrees and(128.0±18.9)degrees respectively after the fully opening of the cervical orifice for1 hour.The average values of MA in group A and group B were(28.1±8.1)degrees and(118.2±16.4)degrees respectively after the fully opening of the cervical orifice for 2 hours.There were significant differences in AOP and MA between the two groups at three time points(P＜0.05).Logistic regression analysis showed that fetal weight is the largest risk factor affecting delivery outcomes.The receiver operating characteristic suggested that AOP is superior to MA in diagnosis.According to the receiver operating characteristic,the cutoff values of 0h AOP,1h AOP and 2h AOP were 118 degrees,129 degrees and 142 degrees respectively.The cutoff values of 0h MA,1h MA and 2h MA were 94 degrees,74 degrees and 45 degrees respec-tively.Conclusion:Measuring the parameters of angle of progression and midline angle by intra-partum transperineal ultrasound can accurately and effectively evaluate the progress of non-oc-cipital-anterior vaginal labor,reduce the pain of vaginal digital examination and the risk of in-fection,timely intervene in the labor process,and avoid the occurrence of serious complications of maternal and infant delivery.