产时超声与体位指导在异常胎方位管理中的应用进展

doi:10.3761/j.issn.2096-7446.2025.10.022

摘要/Abstract

摘要：

产时超声与体位指导指通过经腹或会阴超声与自由体位结合的方式为异常胎方位的患者提供更加精准的产程管理方式。该文综述了产时超声与体位指导在异常胎方位中实施价值、护理干预方案及效果评价、应用障碍及前景，旨在探索产时超声与体位指导在异常胎方位管理中的潜在积极作用，以期为阴道分娩患者提供更加舒适、安全、精确的检查及指导方式，促进阴道分娩，保障母婴安全，但临床规范化实施标准需进一步建立和完善。

关键词: 产时超声, 体位指导, 胎方位, 阴道分娩, 综述文献

Abstract:

Intrapartum ultrasound and postural guidance is to provide more accurate labor management for patients with abnormal fetal orientation through the combination of abdominal or perineal ultrasound and free postural position. This paper reviewed the value of intrapartum ultrasound and postural guidance in the treatment of abnormal fetal orientation，nursing intervention plan and effect evaluation，application obstacles and prospects. This review aimed to explore the potential positive effects of intrapartum ultrasound and postural guidance in the management of abnormal fetal orientation，with a view to providing more comfortable，safe and accurate examination and guidance methods for vaginal delivery patients，promoting vaginal delivery and ensuring the safety of mother and child. However，the standardization of clinical implementation needs to be further established and improved.

Key words: Intrapartum Ultrasound, Postural Guidance, Fetal Orientation, Vaginal Delivery, Review Literature as Topic

王方方, 张焱, 张莉莉, 李偲偲, 王华芬. 产时超声与体位指导在异常胎方位管理中的应用进展[J]. 中华急危重症护理杂志, 2025, 6(10): 1276-1280.

WANG Fangfang, ZHANG Yan, ZHANG Lili, LI Sisi, WANG Huafen. Progress on the application of intrapartum ultrasound and postural guidance in the management of abnormal fetal orientation[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(10): 1276-1280.

参考文献 25

[1]	刘婷婷, 杨杰, 赵娜, 等. 产时超声在初产妇阴道试产产程中的临床应用价值研究[J]. 西藏医药, 2024, 45(3):32-34.
	Liu TT, Yang J, Zhao N, et al. Clinical application value of intrapartum ultrasound in vaginal trial labor of primipara[J]. Tibet Med, 2024, 45(3):32-34.
[2]	程贤鹦, 张朋辉, 王园园, 等. 三孩产妇的妊娠特征和分娩方式及围生儿结局的研究[J]. 中国计划生育学杂志, 2023, 31(11):2544-2549.
	Cheng XY, Zhang PH, Wang YY, et al. Study on pregnancy characteristics,delivery mode,and perinatal outcomes of women with third-child[J]. Chin J Fam Plan, 2023, 31(11):2544-2549.
[3]	杨建成, 马琰, 徐颖, 等. 胎方位异常阴道分娩第二产程会阴超声测量产程进展参数的临床研究[J]. 现代妇产科进展, 2024, 33(9):656-661.
	Yang JC, Ma Y, Xu Y, et al. Clinical study on intrapartum transperineal ultrasound measurement of parameters of the second labor progress in non occipital anterior vaginal deli-very management[J]. Prog Obstet Gynecol, 2024, 33(9):656-661.
[4]	刘洪莉, 李俊男. 《产时超声:世界围产医学会和围产医学基金会临床实践指南和推荐》解读[J/OL]. 中国产前诊断杂志(电子版), 2022, 14(3):1-7.
	Liu HL, Li JN. ntratural ultrasound:clinical practice guidelines and recommendations of the world perinatal medical associa-tion and the perinatal medicine foundation[J/OL]. Chin J Pre-nat Diagn Electron Version, 2022, 14(3):1-7.
[5]	Gilboa Y, Perlman S. Intrapartum ultrasound for the manage-ment of the active pushing phase[J]. Am J Obstet Gynecol MFM, 2021, 3(6S):100422.
[6]	刘洪莉, 张兰, 漆洪波. 国际妇产科超声学会实践指南解读:产时超声[J]. 中国实用妇科与产科杂志, 2019, 35(2):206-209. doi: 10.19538/j.fk2019020118
	Liu HL, Zhang L, Qi HB. Interpretation of the practice gui-delines of the international society of ultrasound in obstetrics and gynecology:Intratural ultrasound[J]. Chin J Pract Gynecol Obstet, 2019, 35(2):206-209.
[7]	章玉霞, 廖瑞碧, 苏明松. 产时超声替代阴道指检在初产妇阴道试产中的应用研究[J]. 中国医疗器械信息, 2023, 29(6):16-18,53.
	Zhang YX, Liao RB, Su MS. Application of prenatal ultrasound instead of vaginal digital examination in vaginal trial delivery of primipara[J]. China Med Device Inf, 2023, 29(6):16-18,53.
[8]	侯书梅, 辛静, 袁悦. 产时超声配合体位矫正胎方位在头位镇痛分娩中的应用[J]. 新疆医学, 2023, 53(8):973-975,990.
	Hou SM, Xin J, Yuan Y. Application of the ultrasound exami-nation combined with the body posture applying in the fetal position correction duringcephalic analgesic delivery[J]. Xin-jiang Med J, 2023, 53(8):973-975,990.
[9]	Wiafe YA, Whitehead B, Venables H, et al. Intrapartum ultra-sound assessment of cervical dilatation and its value in detecting active labor[J]. J Ultrasound, 2018, 21(3):233-239. doi: 10.1007/s40477-018-0309-2 pmid: 30056591
[10]	Rizzo G, Ghi T, Henrich W, et al. Ultrasound in labor:clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Me-dicine Foundation[J]. J Perinat Med, 2022, 50(8):1007-1029.
[11]	张勤建, 颜建英. 产时超声辅助产程管理[J]. 中国实用妇科与产科杂志, 2024, 40(2):142-147.
	Zhang QJ, Yan JY. Use of intrapartum ultrasound to assist labor management[J]. Chin J Pract Gynecol Obstet, 2024, 40(2):142-147.
[12]	Lee CH, Choi SS, Lee MK, et al. Electric stimulation-guided epidural analgesia for vaginal delivery:a randomized prospec-tive study[J]. PLoS One, 2019, 14(1):e0209967.
[13]	蔡军红, 蔡诗琪, 贺英英, 等. 分娩镇痛初产妇采用自由体位纠正胎方位异常的研究[J]. 护理学杂志, 2024, 39(12):41-43.
	Cai JH, Cai SQ, He YY, et al. Study on the use of free posi-tion delivery for correcting abnormal fetal positions in primi-parous women during labor analgesia[J]. J Nurs Sci, 2024, 39(12):41-43.
[14]	Seval MM, Yuce T, Kalafat E, et al. Comparison of effects of digital vaginal examination with transperineal ultrasound dur-ing labor on pain and anxiety levels:a randomized controlled trial[J]. Ultrasound Obstet Gynecol, 2016, 48(6):695-700. doi: 10.1002/uog.15994 pmid: 27300158
[15]	Alfirevic Z, Edwards G, Platt MJ. The impact of delivery suite guidelines on intrapartum care in ‘standard primigravida’[J]. Eur J Obstet Gynecol Reprod Biol, 2004, 115(1):28-31. doi: 10.1016/j.ejogrb.2003.10.036 pmid: 15223161
[16]	曹灵丽, 凌奇. B超引导下行单胎臀位外倒转的有效性及安全性探讨[J]. 实用妇科内分泌电子杂志, 2024, 11(18):17-19.
	Cao LL, Ling Q. Study on the effectiveness and safety of external breech inversion of single fetus guided by B-ultra-sound[J]. Electron J Pract Gynecol Endocrinol, 2024, 11(18):17-19.
[17]	Palepu PM, Anand K, Ghosh SK, et al. Factors associated with intrapartum cesarean section after a successful external cephalic version[J]. J Matern Fetal Neonatal Med, 2022, 35(25):9038-9042.
[18]	林春霞, 周隽, 毛胜艳, 等. 艾灸至阴穴联合胸膝卧位矫正孕晚期单胎臀位对分娩方式和母婴结局的影响[J]. 中医学报, 2024, 39(5):1109-1113.
	Lin CX, Zhou J, Mao SY, et al. Effect of moxibustion at “Zhiyin” combined with chest-knee position in correcting late pregnancy breech position on delivery mode as well as mother-infant outcome[J]. Acta Chin Med, 2024, 39(5):1109-1113.
[19]	Dall’Asta A, Melito C, Ghi T. Intrapartum ultrasound guidance to make safer any obstetric intervention:fetal head rotation,assisted vaginal birth,breech delivery of the second twin[J]. Clin Obstet Gynecol, 2024, 67(4):730-738.
[20]	许佩杏. 第二产程中采取自由体位对分娩效果影响分析[J]. 数理医药学杂志, 2017, 30(10):1473-1474.
	Xu PX. Analysis of effect of free position on childbirth in the second stage of labor[J]. J Math Med, 2017, 30(10):1473-1474.
[21]	Cuerva MJ, Rodriguez E, Perez De Aguado M, et al. Intrapar-tum ultrasound in maternal lateral versus semi-recumbent posture. A repeated measures study[J]. Eur J Obstet Gynecol Reprod Biol, 2023,285:46-49.
[22]	Mei-Dan E, Jain V, Melamed N, et al. Guideline No. 428:ma-nagement of dichorionic twin pregnancies[J]. J Obstet Gynae-col Can, 2022, 44(7):819-834.
[23]	Barrett JFR, Hannah ME, Hutton EK, et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy[J]. N Engl J Med, 2013, 369(14):1295-1305.
[24]	Fieni S, Di Ilio C, Kiener AJO, et al. Real-time ultrasound to assist during a vaginal breech delivery[J]. Am J Obstet Gyne-col, 2024, 230(3):S1044-S1045.
[25]	Malvasi A, Malgieri LE, Stark M, et al. Dystocia,delivery,and artificial intelligence in labor management:perspectives and future directions[J]. J Clin Med, 2024, 13(21):6410.