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(P<0.05);多因素分析表明胎儿头围的大小是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:0.684~0.853),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(P<0.05)。完全损伤组与部分损伤组分别与完整组的各因素比较,差异均无统计学意义(P>0.05),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。
Objective To explore the risk factors of transperineal ultrasound tomography(TUI)in diagnosing 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.Methods 137 primiparous women with a gestational age of over 39 weeks were selected for timely prenatal examination.Intrauterine ultrasound measurements of fetal head circumference,biparietal diameter,and abdominal circumference were performed within 7 days before delivery.The 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 TUI 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.Statistical 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 analyzed whether there was a statistical difference between the complete injury group and the partial injury group in many influencing factors.Results The 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 levator ani muscle group,and all three groups were statistically significant(P<0.05).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 injury 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%in the intact group.The difference between the two groups was statistically significant(P<0.05).Compared with the intact group,the complete injury group and partial injury group showed no statistically significant differences in all factors(P>0.05),and multivariate analysis showed that lateral episiotomy was not an independent risk factor for levator ani muscle injury;Conclusion The size of the fetal head circumference during vaginal delivery by primiparous 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 independent risk factor for levator ani muscle injury during vaginal delivery in primiparous women.
作者
崔玉梅
王春光
李华林
陈旭
CUI Yumei;WANG Chunguang;LI Hualin;CHEN Xu(Medical imaging College of Weifang Medical University,Weifang 261053,China;Department of Ultrasound,Zibo Maternal and Child Health Hospital,Zibo 255000,China;Department of Ultrasound,Weifang People's Hospital,Weifang 261042,China)
出处
《医学影像学杂志》
2024年第2期82-86,共5页
Journal of Medical Imaging
关键词
超声断层显像
胎儿头围
会阴侧切
肛提肌损伤
超声检查
Ultrasound tomography imaging
Fetal head circumference
Lateral episiotomy
Levator ani muscle injury
Ultrasound
