| 摘要: |
| 目的 应用经会阴超声测量宫颈后角和进展角，探讨其在预测Bishop评分＜4分的妊娠足月初产妇使用地诺前列酮栓引产后阴道分娩的临床价值。方法 前瞻性选取于我院接受引产的Bishop评分＜4分的妊娠足月初产妇，均使用地诺前列酮栓促宫颈成熟引产，根据引产结局分为阴道分娩组和剖宫产组，比较两组引产前一般资料及超声指标的差异，采用Logistic回归分析预测引产后阴道分娩的独立影响因素，绘制受试者工作特征（ROC）曲线评估其预测效能。结果 共纳入381例初产妇，包括阴道分娩组335例和剖宫产组46例。与剖宫产组比较，阴道分娩组产妇年龄更小，宫颈更短，宫颈后角及进展角更大，差异均有统计学意义（均P＜0.05）。Logistic回归分析显示，校正年龄因素后，宫颈后角[OR=0.948（95%可信区间：0.932~0.964），P＜0.001]和进展角[OR=0.955（95% 可信区间：0.920~0.991），P=0.015]均为引产后经阴道分娩的独立预测因素。ROC曲线分析显示，宫颈后角预测引产后经阴道分娩的灵敏度为68.40% ，特异度为84.80%，曲线下面积为0.843（95%可信区间：0.782~0.904），进展角预测引产后阴道分娩的灵敏度为82.10% ，特异度为50.00%，曲线下面积为0.652（95%可信区间：0.554~0.750）。宫颈后角的曲线下面积高于进展角，差异有统计学意义（P=0.001）。结论 对于Bishop评分＜4分的妊娠足月初产妇，宫颈后角和进展角均为引产后阴道分娩的独立预测因素，且宫颈后角的预测效能更好。 |
| 关键词: 超声检查，经会阴 宫颈后角 进展角 Bishop评分 引产 |
| DOI： |
| 投稿时间：2023-05-26修订日期：2023-12-13 |
| 基金项目:安徽省高校自然科学研究项目（2023AH050580） |
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| Clinical value of posterior cervical angle and angle of progression in predicting vaginal delivery after induced labor |
| wang Yin,Chen Xianxia,Huang Ting,Liu Dehong,Ruan Jing,Ding Ruyuan |
| (Anhui Province Maternity and Child Health Hospital) |
| Abstract: |
| Objective To investigate the value of cervical posterior horn and progression angle measured by transperineal ultrasound in predicting vaginal delivery after induction of labor with dinoprostone thrombus in pregnant term primiparous women with Bishop score＜4 points.Methods Selected pregnant term primiparous women who underwent induction of labor between June 2021 and June 2022 in Anhui maternal and child health hospital，using dinoprostone thrombus to induce cervical ripening induction of labor，divided into vaginal delivery group and cesarean section group according to the induction outcomes，compared the two groups of general information and ultrasound before induction of labor，determined the indicators that had the independent predictive ability for vaginal delivery after induction using logistic regression analysis，assessed the predictive efficacy of the indicators using ROC curve，The Youden index was used to determine the optimal threshold value of the index，and the sensitivity and specificity were calculated.Results A total of 381 parturients were included in the final analysis，of whom 335 were delivered vaginally and 46 by cesarean section，compared with the cesarean section group，and the parturients in the vaginal delivery group had a younger age，a shorter cervix，and a greater posterior cervical horn and rudimentary horn，with statistically significant differences （P＜0.05）.Logistic regression analysis showed that the posterior cervical horn （or：0.948，95% CI：0.932-0.964，P = 0.000） and the progressive horn （or：0.955，95% CI：0.920-0.991，P =.0015） were independent predictors of vaginal birth after induction of labor. ROC curve analysis showed that the sensitivity, specificity, and area under curve of posterior cervical angle predicting vaginal delivery after induced labor were 68.40%, 84.80%, and 0.843 (95% confidence interval: 0.782~0.904). The sensitivity, specificity and AUC of angle of progression predicting vaginal delivery after induced labor were 82.10%, 50.00% and 0.652 (95% confidence interval: 0.554~0.750). The area under the curve of posterior cervical angle was higher than that of angle of progression, and the differences were statistically significant (P=0.001).Conclusion For pregnant term primiparous women with a Bishop score＜4 points，the posterior cervical horn，and progression angle were independent predictors of vaginal delivery after induction of labor，and the predictive efficacy of the posterior cervical horn was better. |
| Key words: Ultrasound examination Transperineal Posterior cervical angle Angle of progression Bishop scoring Induction of labor |
