Laborpro三维导航仪测量坐骨棘间径对难产的预测研究

目的探讨Laborpro数字三维导航仪测量坐骨棘间径对孕妇产程中难产的预测价值。方法选择2017年5月至2019年3月在南京医科大学附属常州妇幼保健院产科分娩的1023例初产妇。按最终分娩方式分为三组:产钳组(30例)、剖宫产组(113例)、平产组(880例)。使用Laborpro三维导航仪测量骨盆内径,用B超测量双顶径值,ROC曲线分析双顶径值、坐骨棘间径、坐骨棘间径与双顶径之差对产程中难产的预测价值。结果平产组、产钳组和剖宫产组的坐骨棘间径的中位数(四分位间距)分别为10.30(10.00~10.70)cm、9.86(9.70~10.20)cm和9.80(9.60~10.00)cm,差别具有统计学意义(H=130.248,P <0.001),两两比较发现,与平产组相比,产钳组和剖宫产组的坐骨棘间径均较小。按照不同坐骨棘间径区间划分,分娩方式差别具有统计学意义(χ2=156.455,P <0.001),多重比较发现,在坐骨棘间径≤9.0cm、~≤9.5cm、~≤10.0cm区间中,产钳组和剖宫产组的构成比明显高于平产组,在坐骨棘间径~≤10.5cm、>10.5cm组中,剖宫产组的构成比低于平产组。坐骨棘间径与双顶径之差ROC曲线下面积及95%CI为0.86(0.82~0.89),预测难产最佳,最佳预测值为0.450。结论 Laborpro数字三维导航仪测量坐骨棘间径作为一种客观精确、无辐射、简单易行的检查方法,结合胎儿双顶径值,对孕妇产程中难产的预测有重要价值。

Value of Laborpro three-dimensional navigator in predicting difficult labor

Objective To explore the value of using Laborpro digital three-dimensional navigator to measure the diameter of the ischial spine to predict difficult labor in pregnant women. Methods 1,023 primiparas who gave birth during the period from May 2017 to March 2019 in Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University were subjects. According to the final delivery method, the subjects were divided into three groups: the forceps group(30 cases), the cesarean section group(113 cases), and the natural birth group(880 cases). The inner diameter of the pelvis was measured by the Laborpro 3 D navigator, and the biparietal diameter was measured with B-ultrasound. ROC curve was used to analyze the predictive value of the biparietal diameter, the diameter of the ischial spine, and the difference between the ischial spine diameter and the biparietal diameter in the labor process. Results In the natural birth group,the forceps group and the cesarean group, the median(interquartile range) of the ischial spine diameter was 10.30(10.00 ~ 10.70)cm, 9.86(9.70 ~ 10.20) cm and 9.80(9.60 ~ 10.00)cm, respectively, and the difference was statistically significant(H = 130.248, P<0.001). Pairwise comparison showed that the ischial spine diameter in the forceps group and the cesarean group was smaller than that of the natural birth group. According to the diameter interval of different ischial spines, the difference of delivery mode was statistically significant(χ2 = 156.455, P<0.001). Multiple comparisons showed that in the circumstance of ischial spine diameter level ≤ 9.0 cm, ~≤ 9.5 cm, ≤ 10.0 cm, the composition ratio of forceps group and cesarean group was significantly higher than that in the natural birth group;in the setting of the ischial spine diameter level ≤ 10.5 cm,>10.5 cm, the composition of cesarean group was significantly lower than that in the natural birth group. The ROC curve of the difference between biparietal diameter and the ischial spine diameter and 95%CI was 0.86(0.82 ~ 0.89), which was the best prediction for dystocia, and the cut value was 0.450. Conclusion As an objective, accurate, radiation-free and simple inspection method, Laborpro digital 3 D navigator can be used to measure interspinous diameter;and combined with biparietal diameter, it can predict dystocia during abnormal labor process.