孕晚期胎儿头围的测量预测肛提肌损伤的价值.pdf
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1、医学影像学杂志2024年第34 卷第2 期 J Med Imaging Vol.34 No.2 2024孕晚期胎儿头围的测量预测肛提肌损伤的价值崔玉梅1,2,王春光3,李华林2,陈旭21.潍坊医学院医学影像学院 山东 潍坊 261053;2.山东省淄博市妇幼保健院超声科 山东 淄博 255000;3.山东省潍坊市人民医院超声科 山东 潍坊 261042【摘 要】目的探讨经会阴超声断层显像(TUI)诊断肛提肌损伤(LAMI)的危险因素,分析危险因素在预测初产妇经阴道分娩过程中 LAMI 的价值。方法选取孕龄39 周按时产检的初产妇 137 例,分娩前 7 天内对其进行胎儿头围、双顶径及腹围的宫内
2、超声测量,对经阴道分娩过程中有无会阴侧切以及产时胎儿体重统计。产后 42 天对产妇肛提肌的完整性行超声检查,依据经会阴 TUI 模式的结果分为 4 组:肛提肌总损伤组、完全损伤组、部分损伤组、完整组。应用统计学方法将肛提肌总损伤组、完全损伤组及部分损伤组分别与完整组分析比较,分别统计各两组之间在年龄、胎儿头围、双顶径、腹围、体重及有无会阴侧切方面是否存在统计学差异并分析 LAMI 的独立危险因素。比较分析完全损伤组与部分损伤组在诸多影响因素中有无统计学差异。结果肛提肌总损伤组、完全损伤组及部分损伤组胎儿头围的数值均大于肛提肌完整组,三组比较差异均有统计学意义(P0.05);多因素分析表明胎儿头
3、围的大小是 LAMI 的独立危险因素;其预测孕妇产后 LAMI 的 ROC 曲线下面积为 0.769(95%CI:0.6840.853),最佳界值为胎儿头围 338 mm,敏感度为76.0%,特异度为 84.5%;肛提肌总损伤组的会阴侧切率 50.9%,高于完整组的 32.1%,两组比较差异有统计学意义(P0.05),且多因素分析表明会阴侧切术并非 LAMI 的独立危险因素。结论初产妇经阴道分娩时胎儿头围的大小与 LAMI 的发生相关,是 LAMI 的独立危险因素;经阴道分娩时胎儿头围的大小与 LAMI 发生的类型无关;会阴侧切并非初产妇经阴道分娩 LAMI 的独立危险因素。【关键词】超声断层
4、显像;胎儿头围;会阴侧切;肛提肌损伤;超声检查中图分类号:R714.46;R445.1 文献标识码:A 文章编号:1006-9011(2024)02-0082-05The application value of measuring fetal head circumference in late pregnancy and predicting intrapartum injury of the levator ani muscleCUI Yumei1,2,WANG Chunguang3,LI Hualin2,CHEN Xu21.Medical imaging College of Weif
5、ang Medical University,Weifang 261053,China2.Department of Ultrasound,Zibo Maternal and Child Health Hospital,Zibo 255000,China3.Department of Ultrasound,Weifang Peoples Hospital,Weifang 261042,China【Abstract】ObjectiveTo explore the risk factors of transperineal ultrasound tomography(TUI)in diagnosi
6、ng levator ani muscle injury(LAMI),and to analyze the value of risk factors in predicting levator ani muscle injury during vaginal delivery in primiparous women.Methods137 primiparous women with a gestational age of over 39 weeks were selected for timely prenatal examination.Intrauterine ultrasound
7、measurements of fetal head circumference,biparietal diameter,and abdominal circumfer作者简介:崔玉梅(1987-),女,潍坊医学院在读医学硕士研究生,主治医师,主要从事超声诊断工作。通信作者:王春光 E-mail:12BASALDELLA L,ORVIETO E,DEI TOS A P,et al.Causes of arachnoid cyst development and expansionJ.Neurosurg Focus,2007,22(2):94-101.13耿健,王迎宾,马云富.胎儿期四叠体池囊肿
8、合并重度脑积水进展演变1例 J.中国临床神经外科杂志,2021,26(10):815-816.14景柏华,陈俊雅,李晨.产前诊断胎儿鞍上池囊肿:五例临床分析 J.中华围产医学杂志,2021,24(10):728-733.15靳俊功,张莹,孙崇阳,等.颞叶蛛网膜囊肿伴癫痫患者的临床相关特点J.临床医学研究与实践,2021,6(5):119-121.16LI L,ZHANG Y,LI Y,et al.The clinical classification and treatment of middle cranial fossa arachnoid cysts in children J.Clin
9、ical Neurology&Neurosurgery,2013,115(4):411-418.17李晓斌,王威,周跃.儿童蛛网膜囊肿破裂继发慢性硬膜下血肿分析(附二例报告)J.中华神经外科杂志,2013,29(6):579-581.18孙振环,王德广.MRI、C T联合诊断颅内蛛网膜囊肿破裂1例 J.医学影像学杂志,2015,25(6):965.(收稿日期:2022-10-28)82医学影像学杂志2024年第34 卷第2 期 J Med Imaging Vol.34 No.2 2024ence were performed within 7 days before delivery.The
10、presence or absence of perineal lateral incision during vaginal delivery and fetal weight during delivery were measured.On the 42nd day after delivery,ultrasound examination was performed on the integrity of the anal levator muscle in postpartum women.According to the results of the transperineal TU
11、I pattern,they were divided into four groups:total injury group,complete injury group,partial injury group,and complete group.Using statistical methods,the total injury group,complete injury group,and partial injury group of the levator ani muscle were analyzed and compared with the complete group.S
12、tatistical differences in age,fetal head circumference,biparietal diameter,abdominal circumference,weight,and the presence or absence of perineal lateral incision were analyzed between each two groups,and independent risk factors for levator ani muscle injury were analyzed.Finally,we compared and an
13、alyzed whether there was a statistical difference between the complete injury group and the partial injury group in many influencing factors.ResultsThe fetal head circumference values of the total,complete,and partial injury groups of the levator ani muscle were all higher than those of the intact l
14、evator ani muscle group,and all three groups were statistically significant(P0.05).Multivariate research analysis showed that the size of fetal head circumference was an independent risk factor for levator ani muscle injury;The area under the ROC curve for predicting postpartum anal levator muscle i
15、njury in pregnant women was 0.769(95%CI:0.684-0.853),with the optimal cutoff value being the fetal head circumference of 338 mm,sensitivity of 76.0%,and specificity of 84.5%;The perineal lateral resection rate in the total injury group of the levator ani muscle was 50.9%,which was higher than 32.1%i
16、n the intact group.The difference between the two groups was statistically significant(P0.05),and multivariate analysis showed that lateral episiotomy was not an independent risk factor for levator ani muscle injury;ConclusionThe size of the fetal head circumference during vaginal delivery by primip
17、arous women is related to the occurrence of levator ani muscle injury,and is an independent risk factor for levator ani muscle injury;The size of the fetal head circumference during vaginal delivery is not related to the type of injury to the levator ani muscle;Lateral episiotomy is not an independe
18、nt risk factor for levator ani muscle injury during vaginal delivery in primiparous women.【Key words】Ultrasound tomography imaging;Fetal head circumference;Lateral episiotomy;Levator ani muscle injury;Ultrasound肛提肌损伤(levator ani muscle injury,LAMI)是女性经阴道分娩最常见的肌肉损伤,随着生育政策的开放 LAMI的问题日益严重,对女性日常生活与工作产生严
19、重的不良影响1。常见的产后并发症有压力性尿失禁(stress urinary incontinence,SUI)、盆腔脏器脱垂(pelvic organ prolapse,POP)、直肠膨出等,严重者甚至发生肛提肌断裂撕脱而需要手术干预2。本文通过对初产妇经阴道分娩的产前胎儿头围的测量、产时会阴侧切率的分析以及产后经会阴TUI技术诊断LAMI程度,探讨胎儿因素和产时因素预测 LAMI的价值,对初产妇选择分娩方式具有指导意义。1资料与方法1.1临床资料选取2022年1至12月淄博市妇幼保健院产科门诊定期产检的初产妇137例,年龄2035岁,平均年龄(27.8 3.2)岁。纳入标准:1)单胎妊娠的
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- 晚期 胎儿 测量 预测 肛提肌 损伤 价值
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