پیشگویی پیشرفت مرحله اول زایمان با تغییرات طول خط بنفش

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دکترای تخصصی بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تربت‌حیدریه، تربت‌حیدریه، ایران. دکترای تخصصی بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 استادیار گروه مامایی، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 استاد گروه آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

چکیده

مقدمه: خط بنفش (یک نقطه بنفش رنگ که در اطراف مقعد در لیبر در زنان ظاهر و همزمان با اتساع دهانه رحم پیشرفت می‌کند) به‌عنوان یکی از روش‌های غیرتهاجمی ارزیابی پیشرفت زایمان است که در اکثریت زنان طی لیبر بروز پیدا می­کند. مطالعه حاضر با هدف تعیین ارزش تشخیصی تغییرات طول خط بنفش در پیشگویی پیشرفت زایمان در فاز فعال زایمانی انجام شد.
روش‌کار: این مطالعه قدرت تشخیصی در سال 1391 بر روی 258 زن باردار بستری در زایشگاه بیمارستان ام‌البنین (س) شهر مشهد با سن حاملگی ترم، نمایش قله سر جنین و شروع فاز فعال زایمان که دارای ظهور خط بنفش بودند، انجام شد. معاینه مهبلی و اندازه‌گیری طول خط بنفش هر 1 ساعت یک بار در فاز فعال زایمان انجام شد. بعد از تعیین نقطه برش بر اساس منحنی راک؛ حساسیت، ویژگی، ارزش اخباری مثبت و منفی محاسبه شد. داده‌ها با کمک پرسشنامه‌های: اطلاعات فردی- بارداری و فرم پیشرفت زایمان و اطلاعات مربوط به خط بنفش جمع‌آوری گردید. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 16)، منحنی راک، حساسیت، ویژگی، ارزش اخباری مثبت و منفی انجام شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شد.
یافته‌ها: افزایش طول خط بنفش در هر مرحله اتساع دهانه رحم با پیشرفت زایمان در همان مرحله همراه بود و در اتساع 5-3 سانتی‌متری دهانه رحم، طول خط بنفش بیشتر و مساوی 85 میلی‌متر با حساسیت 93%، ویژگی 100% و ارزش اخباری مثبت 100%، ارزش اخبار منفی 3/33% و اعتبار 22/93% با پیشرفت زایمان در همان مرحله همراه بود و دارای بیشترین ارزش تشخیصی بود.
 نتیجه‌گیری: اندازه­گیری تغییرات طول خط بنفش در مرحله اول زایمان یعنی در اتساع 5-3 سانتی‌متری دهانه رحم، ≥85 میلی‌متر، در اتساع 8-6 سانتی‌متری دهانه رحم، طول خط بنفش ≥5/101 میلی‌متر و در اتساع 10-9 سانتی‌متری اتساع دهانه رحم، طول خط بنفش ≥5/110 میلی‌متر با بیشترین حساسیت با اتساع دهانه رحم در ارتباط بود و به‌عنوان یک روش غیر‌تهاجمی برای پیشگویی پیشرفت زایمان در مرحله اول زایمان در بالین توصیه می­گردد.

کلیدواژه‌ها


عنوان مقاله [English]

Purple line Alteration in prediction of labor progress

نویسندگان [English]

  • Morvarid Irani 1
  • Masomeh Kordi 2
  • Habibollah Esmaeili 3
1 PhD in Reproductive Health, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. PhD in Reproductive Health, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Assistant Professor, Department of Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Professor, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: The purple line as a purple point around anus that occurs in the majority of women during labor is one of the non-invasive methods for evaluation of labor progress. This study was performed aimed to determine the diagnostic accuracy of purple line alteration in prediction of labor progress in active phase of labor.
Methods: This diagnostic power study was conducted in 2012 on 258 pregnant women with term pregnancy in vertex presentation and beginning of active phase of labor with the appearance of a purple line who were hospitalized in Ommolbanin Hospital. Vaginal examination and purple line observation in the active phase of labor were measured each hour. Sensitivity, specificity, positive and negative predictive value were calculated after determining the cut-off point. Data were collected using the questionnaires: personal-pregnancy information and labor progress form and information about the purple line. Data were analyzed by SPSS statistical software (version 16), ROC curve, sensitivity, specificity, positive and negative predictive value. P<0.05 was considered statistically significant.
Results: Increasing the purple line length at each stage of the cervical dilation was associated with the labor progression at that stage. In 3-5 cm cervical dilation, the length of the purple line ≥85 mm was associated with a sensitivity of 93%, specificity 100% and positive predictive value 100%, negative predictive value 33.3% and validity 93.22% with labor progress at the same stage and had the highest diagnostic value
Conclusions: Measurement of purple line alteration in the first stage of labor that is, in 3-5 cm cervical dilation, ≥85 mm, 6-8 cm cervical dilation ≥101.5 mm and 9-10 cm cervical dilation ≥110.5 mm was associated with most sensitivity with cervical dilatation and is recommended as a non-invasive method to predict clinical  labor progress in the first stage of delivery.

کلیدواژه‌ها [English]

  • Active phase of labor
  • Dystocia
  • purple line
  • sensitivity
  • specificity
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