胎儿半肩径超声检查在难产中的应用研究

　　[摘要] 目的 探讨超声测量胎儿半肩径的方法及临床应用价值。 方法 对我院559例单胎孕37～41周的孕妇进行超声检查，测量胎儿半肩径、双顶径、头围、腹围、股骨长，计算半肩径与双顶径及半肩径与腹围的比值，与出生体重相比较，分析胎儿半肩径与胎儿难产的关系，意图找出胎儿半肩径的测量对难产的评估价值。 结果 巨大儿组半肩径、双顶径、头围、腹围、股骨长出生体重和半肩径/双顶径大于正常儿组，差异有统计学意义（P<0.01）；肩难产组双顶径、头围、腹围、半肩、出生体重、半肩径/双顶径、半肩径/腹围大于正常组，差异有统计学意义（P<0.01）；胎儿半肩径与出生体重呈正相关关系（r=0.722，P<0.01）。 结论 胎儿半肩径与肩难产之间呈正相关关系，超声测量胎儿半肩径对预警胎儿肩难产具有一定的意义。
　　[关键词] 半肩径；彩色多普勒超声；肩难产；半肩径/双顶径
　　[中图分类号] R651.3 [文献标识码] B [文章编号] 1673-9701（2018）08-0053-03
　　Effectiveness of applying ultrasound test of fetal half shoulder diameter on dystocia
　　WANG Jianchun LAN Qiuju ZHANG Dongfang YANG Sufen WANG Qian
　　Chengde Maternity & Child Healthcare Hospital in Hebei Province， Chengde 067000， China
　　[Abstract] Objective To investigate the measure method of fetal half shoulder diameter using ultrasound test and its clinical value. Methods 559 pregnant women in our hospital who were singleton pregnancy and the gestational age was between 37 and 41 weeks were assessed by ultrasound test. Half shoulder diameter， biparietal diameter （BPD），head circumference， abdomen circumference and femur length of fetus were measured. The ratio of half shoulder diameter and BPD and the ratio of half shoulder diameter and abdomen circumference were calculated and compared with birth weight to analyze the relationship between half shoulder diameter of fetus and dystocia and to find out the value of fetus half shoulder diameter measurement on dystocia prediction. Results Half shoulder diameter， BPD， head circumference， abdomen circumference， femur length， birth weight and half shoulder diameter/BPD ratio in fetal macrosomia group were significantly bigger than those in normal group（P<0.01）. BPD， head circumference， abdomen circumference， half shoulder， birth weight， half shoulder diameter/BPD ratio and half shoulder diameter /abdomen circumference ratio in shoulder dystocia group were significantly bigger than those in normal group（P<0.01）. Fetal half shoulder diameter was positively associated with birth weight（r=0.772，P<0.01）. Conclusion Fetal half shoulder diameter was positively associated with shoulder dystocia. Assessment of fetal half shoulder diameter by using ultrasound test could be helpful to alarm fetal shoulder dystocia.
　　[Key words] Half shoulder diameter； Color doppler ultrasound； Shoulder dystocia； Half shoulder diameter/biparietal diameter
　　肩難产是一种高危的产科急症，全球发生率为0.58%～2.40%，因其具有不可预见性而成为产科医师极为关注的重要问题[1]。胎头娩出后，胎儿前肩被嵌顿在耻骨联合上方，用常规助产方法不能娩出胎儿双肩，称为肩难产[2]。以胎头胎体娩出时间间隔定义肩难产证据不足。其发生率因胎儿体重而异，胎儿体重2500～4000 g时发生率为0.3%～1.0%，4000～4500 g时发生率为3%～12%，≥4500 g为8.4%～14.6%[3-5]。超过50%的肩难产发生于正常体重的新生儿，且事先无法预测[6]。本项研究旨在通过测量胎儿半肩径，计算胎儿半肩径与双顶径的比值以及计算胎儿半肩径与腹围的比值，作为预测肩难产发生风险的胎儿超声指标，能够给临床提出指导性建议，以期早期预测肩难产，增加临床预判能力，现报道如下。

相关热词搜索：难产 超声 胎儿 检查 研究