経腹膜超音波測定の実行可能性、信頼性、一致性。縦断的コホート研究の結果

Feasibility, Reliability, and Agreement of Transperineal Ultrasound Measurement: Results from a Longitudinal Cohort Study.

• Angel H W Kwan
• Piya Chaemsaithong
• Wing Ting Tse
• Kubi Appiah
• Ka Chun Chong
• Tak Yeung Leung
• Liona C Poon

抄録

目的:

経腹膜超音波（TPU）による胎児頭部位置（副矢状進行角[psAOP]、頭頂周囲距離[HPD]、頭頂周囲距離[HSD]）および超音波子宮頸部拡張（SCD）の評価の実行可能性、信頼性、および一致性を、それぞれ経膣検査による胎児頭部位置および子宮頸部拡張と比較して評価すること。

OBJECTIVES: To evaluate the feasibility, reliability, and agreement of serial transperineal ultrasound (TPU) assessment of fetal head station (parasagittal angle of progression [psAOP], head-perineum distance [HPD], and head-symphysis distance [HSD]) and sonographic cervical dilatation (SCD), compared to fetal head station and cervical dilatation determined by vaginal examination, respectively.

方法:

本研究は、定期的に陣痛を誘発している単胎妊娠者を対象とした前向き縦断的研究である。腟検査による胎児頭位と子宮頸部拡張のペア評価と、psAOP、HPD、HSD、SCDのTPU評価を連続的に行った。その妥当性、相関性、信頼性、一致性を検討した。

METHODS: This was a prospective longitudinal study in singleton pregnancies undergoing induction of labor at term. Paired assessment of fetal head station and cervical dilatation by vaginal examination, with TPU assessment of psAOP, HPD, HSD, and SCD was made serially. Feasibility, correlation, reliability, and agreement were determined.

結果:

326人の女性のうち1,139人のペア測定が含まれています。胎児頭位が高かったため、3.4％（11/326人）でHSDは達成できなかった。経膣検査による胎児頭位置はpsAOP（rho = 0.70）と正の相関があったが、HPD（rho = -0.57）およびHSD（rho = -0.52）とは負の相関があった。SCDの測定可能性は、頸部拡張が増加するにつれて低下した。子宮頸部拡張とSCDは正の相関があり（rho = 0.96）、強い一致がみられた（一致相関係数 = 0.925）。

RESULTS: 1,139 paired measurements among 326 women were included. psAOP and HPD were achievable in all assessments. HSD was not achievable in 3.4% (11/326) due to high fetal head station. Fetal head station by vaginal examination was positively correlated with psAOP (rho = 0.70) but negatively correlated with HPD (rho = -0.57) and HSD (rho = -0.52). The feasibility to measure SCD reduced as cervical dilatation increased. Cervical dilatation and SCD were positively correlated (rho = 0.96) with strong agreement (concordant correlation coefficient = 0.925).

結論:

psAOPとHPDの測定は可能であり、経腟検査による胎児の頭位と有意な相関がある。HSDの測定は、胎児の頭位が高い場合には実行可能ではありません。SCDの測定は可能であるが、陣痛が進行している場合には困難である。SCDと経膣的検査による子宮頸部拡張との相関性、信頼性、一致性は高い。

CONCLUSIONS: Measurements of psAOP and HPD are feasible and correlate significantly with fetal head station by vaginal examination. Measurement of HSD is not feasible when fetal head station is high. Measurement of SCD is feasible, but it is more difficult in the advanced stage of labor. The correlation, reliability, and agreement between SCD and cervical dilatation by vaginal examination are high.

© 2020 S. Karger AG, Basel.