实用临床医药杂志2024，Vol.28Issue(20)：103-107,5.DOI:10.7619/jcmp.20242405
产程进展角、胎头下降距离及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值
Predictive value of labor progression angle,fetal head descent distance,and their change rate in the outcome of vaginal trial delivery of scarred uterus after cesarean section
摘要
Abstract
Objective To investigate the predictive value of labor progress angle(AOP),fetal head descent distance(HPD)and their change rates in the outcome of vaginal trial of cesarean scar uterus.Methods A total of 170 pregnant women who underwent vaginal trial production of scar ute-rus after cesarean section were selected as study subjects,and were divided into successful group and failed group based on the trial production outcomes.Advanced oxidation processes(AOP)and head-perineum distance(HPD)were measured by ultrasound during the active phase of the first stage of labor when the cervix dilated to 4 cm and at 1 hour after the cervix dilated to 4 cm,respectively.The AOP change rate and HPD change rate after 1 hour of progress were calculated.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of AOP,HPD and their change rates in the outcome of vaginal trial production of scar uterus after cesarean section.Delong test was used to compare the differences in area under curves(AUCs).Results Among 170 pregnant women with scarred uterus after cesarean section who were pregnant again,139 cases(success group)were succeed in transvaginal delivery,while 31 cases failed trial delivery,and transferred to cesarean section(failure group).The AOP of the successful group was significantly larger than that of the failed group when the cervix was opened to 4 cm,and the HPD was significantly shorter than that of the failure group(P＜0.05).The AOP change rate and the change rate of HPD of the suc-cessful group were significantly higher than that of the failed group when the cervix dilated to 4 cm and at 1 hour(P＜0.05).The AUC of AOP and HPD in predicting the outcome of vaginal trial de-livery of scar uterus after cesarean section were 0.846 and 0.812 respectively,and AUC predicted jointly by AOP and HPD showed no significant differences compared with AUC predicted separately(P＞0.05).The AUC of the change rate of AOP and HPD in predicting the outcome of vaginal trial delivery of scarred uterus after cesarean section was 0.899 and 0.852 respectively,and the com-bined prediction of AOP change rate and HPD change rate had a higher AUC value than the AUC predicted separately.Its AUC value was higher than that of AOP combined with HPD(P＜0.05).Conclusion The AOP,HPD and their change rates when the uterine orifice expands to 4 cm in the active phase of the first stage of labor have predictive value for the outcome of vaginal trial produc-tion of scarred uterus after cesarean section.关键词
产程进展角/胎头下降距离/瘢痕子宫/阴道试产/剖宫产Key words
progress angle of labor process/the descent distance of the fetal head/scarred uterus/vaginal trial delivery/caesarean section分类
医药卫生引用本文复制引用
王忆君,沈丹萍,袁国芳,陈萍,石云,朱峰,裘琳,王嘉宁..产程进展角、胎头下降距离及其变化率在剖宫产术后瘢痕子宫经阴道试产结局预测中的价值[J].实用临床医药杂志,2024,28(20):103-107,5.基金项目
江苏省苏州市"科教兴卫"青年科技项目(KJXW2021078) （KJXW2021078）
江苏省苏州市吴江区"科教兴卫"项目(WWK202212) （WWK202212）
