| Objective:1.Measure the combined separation distance and left-right misalignment of the pubic bone by transperineal ultrasound to find accurate measurement points and measurement values.2.To evaluate the diagnostic value of transperineal ultrasound in the diagnosis of pubic symphysis of pregnant women,and to provide guidance for the diagnosis of pubic symphysis in pregnant women in late pregnancy.Methods:Prenatal ultrasound examinations were performed at the Obstetrics and Gynecology Clinic of Shanxi Bethune Hospital from December 2018 to January 2020.30 pregnant women in the third trimester of pregnancy with suspected symptom of pubic symphysis(study group)and 30 asymptomatic pregnant women in the third trimester(Control group(1))and 30 cases of infertility and infertility(control group(2)).Transperineal ultrasound was used to measure the pubic symphysis separation distance and left-right misalignment of each group,and the above parameters were measured again by ultrasound before delivery.All data were subjected to relevant statistics.The treatment method was used to compare the differences between the groups.Results:1.Transperineal ultrasound study: Patients enrolled at 36 weeks of pregnancy: The width of the pubic symphysis in the study group was 9.1~ 17.1(14.13±2.59)mm in the wide part and 3.6~8.5(5.67±1.25)mm in the narrow part.The control group(1)The width of the pubic symphysis separation is 1.1 to 9.3(5.94±2.46)mm in the wide part and 1.1~6.3(3.41 ± 1.38)mm in the narrow part;the control group(2)the width of the pubic symphysis gap is 2.0 ~ 8.3 in the wide part(4.22±1.14)mm and 2.5~4.3(3.29 ± 0.54)mm in the narrower part.The width of the pubic symphysis in the study group was significantly larger than that in the control group(1)and the control group(2),P <0.05.The left and right misalignment of the study group was 3.4~5.4(5.02±0.35)mm.In the control group,the left and right misalignment was 0.5~0.9(0.72±0.14)mm.In the control group(2),the left and right misalignment was 0~0.2(0.12±0.03)mm.There was no significant left-right mismatch in the control group.The left-to-right mismatch of the study group was significantly greater than that of the control group(1)and the control group(2),P <0.05.2.Patients enrolled in the transperineal ultrasound study before delivery: The width of the pubic symphysis in the study group was 12.4~25.7(17.45±3.69)mm in the wide part and 4.1~12.8(7.83±1.77)mm in the narrow part.The control group(1)The pubic symphysis separation width is 2.7~12.9(6.91±2.70)mm in the wide part and 1.5~7.1(4.25±1.86)mm in the narrow part.The pubic symphysis separation width in the study group is significantly larger than that in the control group(1)and the control group.(2),P <0.05.The left and right misalignment of the study group was 4.5~7.1(5.79±0.66)mm.In the control group,the left and right misalignment was 0.5~1.9(1.39±0.23)mm.There was no significant left-right mismatch in the control group.The left-to-right mismatch of the study group was significantly greater than that of the control group(1)and the control group(2),P <0.05.3.When the critical value of the pubic symphysis separation is wider at 11.5mm,the area under the ROC curve for diagnosing pubic symphysis separation is 0.920(95% CI:0.854~0.986,P <0.001),and the sensitivity and specificity are 86.7%,respectively.And76.7%.When the critical value of the pubic symphysis separation is 4.5mm,the area under the ROC curve for diagnosing pubic symphysis separation is 0.819(95% CI:0.711~0.927,P <0.001),and the sensitivity and specificity are 73.7% and 86.7 %.4.At 36 weeks of pregnancy in the study group,the wider,narrower,and left-right misalignment of the pubic symphysis was significantly positively correlated with the VAS score(P <0.05),and the correlation coefficients were: 0.481,0.407,and 0.509;At36 weeks of gestation,the wider,narrower,and left-right misalignment of the pubic symphysis was significantly positively correlated with the VAS score(P <0.05),and the correlation coefficients were: 0.616,0.457,and 0.495.Conclusion:Transperineal ultrasound has high diagnostic value for pubic symphysis,and it is a non-invasive and convenient examination method.Ultrasound measurement of the pubic symphysis separation distance can be accurately measured by selecting the wider part of the pubic symphysis,that is,the pubic symphysis curved surface turns parallel The distance between the points,when the pubic symphysis separation distance ≥11.5mm,can be used as a reference value for transperineal ultrasound diagnosis of pubic symphysis. |
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