The Design Clinic Significance On Uterus Inclination Surveyor

With improvement of living standard and misconceptions on the cesarean section, the cesarean section rate has been increasing year on year. According to statistics, the cesarean section rate that was only 5% from 1950s to 1970s,is rising to 50% in 21 century,which is 3 times more than 15% a cap recommended by WHO,increasing in 1980s. However,the statistics show that cesarean section has not improved the neonate condition,on the contrary, raised the short and long term complications of mother and fetal,and risen medical expense. The prediction of dystocia is a key problem to reduce the cesarean section rate. According as uterine action, birth canal,fetal and psychic factor,dystocia has been forecasted . Cephalopelvic relation is the core of dystocia prediction. The fetal lie is the angle between fetal axis and mother axis,include with longitudinal lie and transverse lie and oblique presentation.The annormal fetal lie is an important fator of dystocia. Longitudinal lie is general in normal labor.Transverse lie aslo named shoulder presentation,is annormal fetal lie ,and has to make a cesarean section .Generally, oblique presentation, is a provisional presentation that almost changs to longitudinal lie , occasionally to transverse lie. Different from oblique presentation the angle between fetal axis and mother axi(snamed fetal inclination),the angle between uterus axis and mother axis(named uterus inclination) is found out from clinical practice. Clinical observations show that uterus inclination is connected with dystocia and labor. Short of quantification surveyor of uterus inclination, the accuracy is no guarantee. They have not been reported that the relation beteen uterus inclination and dystocia. We have designed the uterus inclination surveryor. Compared with the fetal inclination measured by ultrasound,is uterus inclination similar to replace?Useing the uterus inclination surveyor,we study the influence factors,and research the relation between uterus inclination and dystocia,and provide with a potential forecasting technique of dystocia.PartⅠThe design on uterus inclination surveyor and the influence factors of uterus inclinationWe design the quantized accurate convenient uterus inclination surveyor(Patent No.: 201020678455.6) to test 108 gravidas, combining clinical medicine and solid geometry with physics,researching clinic significance. There are 66 gravidas from 108 (61%) whose uterus is inclined. 30 gravidas with left inclination is 6.8°±3.9°.Moreover, 36 gravidas with right inclination is 9.3°±4.8°. Odds ratio estimates of pregnant weight,height and fundal height are 1.147,0.844 and 1.207(а=0.1)by LOGISTIC. The relationship between uterus inclination with neonate weight is negative correlation ( r=-0.2595 , p=0.0256 ) .The relationship between uterus inclination with sleep posture and fetal lie is Unsignificance. Pregnant weight,height and fundal height are the important influence factors . The uterus inclination is not affected when posture of gravida and fetal changes. When the uterus inclination is over,correcting fetal position is the first.The further Research is necessary to confirm that the uterus inclination estimates neonate weight.PartⅡThe relation between uterus inclination and fetal inclination by ultrasoundTesting 51 single cephalic term gravidas,we use sine function table to calculate the uterus inclination,under Color Doppler to tag the abdominal shadow of cervical and coccygeal vertebra, by dint of the surveyor horizontal plane, simultaneously measuring the vertical distance from two shadow points to ventral midline and the distance between two shadow points.At same time,we measure uterus inclination using uterus inclination serveyor. Through the matchedt-test of measurement data, there is no significant statistical difference between uterus inclination and fetal inclination ( p=0.7678 ) . The values measured show a linear correlation(r=0.9039, p<0.0001) between uterus inclination and fetal inclination. PartⅢThe significance of uterus inclination(ⅰ)The significance of uterus inclination in cesarean section:Before cesearean section,measure uterus inclination from 74 single cephalic term gravidas of no labor,and report the correction on uterus inclination during operation.The study shows that 4 in 64 samples which uterus inclination is less than 11 degrees ,need artificial correcion.9 in 10 samples which uterus inclination is equal or greater than 11degrees,need artificial correcion.With exact propability test, There is significant statistical difference between two groups of the 11 degrees boundary (p<0.01).(ⅱ)The significance of uterus inclination in natural labor:Before labor and after labor from 0.5 hour to 1 hour,measure uterus inclination from 52 single cephalic term gravidas of no labor,and report the correction on uterus inclination during labor.The study shows that after labor,10 samples ofⅠdegree uterus inclination (uterus inclination equal and less than 5degrees) return to zero,and do not need artificial correcion. 2 in 21 samples ofⅡdegree uterus inclination (uterus inclination more than 5 degrees,and equal and less than 17 degrees) return to zero,and do not need artificial correcion,however,another 19samples do not return zero,go well after artificial correcion.1 sample ofⅡdegree uterus inclination make a cesarean section because of relatively narrow pelvis. 3 samples ofⅢdegree uterus inclination (uterus inclination more than 17 degrees) have not change,and do not return to zero after artificial correcion,at last to make a cesarean section because of arrested labor.It shows that the uterus inclinations forecast dystocia. Someone ofⅡdegree uterus inclination needs artificial correcion.It suggests that someone ofⅢdegree uterus inclination need cesarean section.PartⅣThe modified fundal height of uterus inclination surveyor estimates fetal weightWith the uterus inclination surveyor,measure the distance between the middle upper edge middle of pubic symphysis to the farthest point. Measure general and modified fundal height from 138 single cephalic term gravidas of no labor,and estimate fetal weight.The statistics show that through the matched t-test of measurement data, there is significant statistical difference between general fundal height and modified fundal height(t=9.9,p<0.01).The modified formula of fetal weight estimation is [ modified fundal height(cm)×abdominal circumference(cm)]g,then the precision is 80.4%.The general formula of fetal weight estimation is [general fundal height(cm)×100]g,then the precision is 56%.There is significant statistical difference between two groups(p<0.05). The modified fundal height is more accurate to estimate fetal weight.In summary, The reseach shows the uterus inclination surveyor and the influence factors such as pregnant weight,height and fundal height.Fetal inclination has significant correlation to uters inclination.Fetal inclination could be indirectly estimated by uterus inclination. The uterus inclinations could forecast dystocia.The modified fundal height is more accurate to estimate fetal weight. The uterus inclination surveyor provides with a potential forecasting technique of dystocia.The further Research is necessary to confirm that the uterus inclination estimates neonate weight.