The effect of ultrasonographic characteristics of the second stage of labor on delivery mode and pregnancy outcome of pregnant women with hypertensive disorders complicating pregnancy

He Rongrong; Yang Chunrong; Mu Liang; Shi Ziyun; Deng Chao; Tian Meirong

doi:10.3760/j.issn.1673-4777.2025.09.019

Abstract：Objective To explore the effects of ultrasonographic characteristics of the second stage of labor on delivery mode and pregnancy outcome of pregnant women with hypertensive disorders complicating pregnancy(HDCP).Methods A total of 106 pregnant women with HDCP who were hospitalized and delivered in Shaanxi Provincial People's Hospital from January 2023 to September 2024 were retrospectively selected as the research objects.The angle of fetal head progression(AOP),the distance between fetal head and perineum(HPD),and the distance between fetal head and pubic symphysis(HSD)were measured by intrapartum ultrasound during the second stage of labor.The delivery mode and pregnancy outcome were recorded.Multivariate Logistic regression was used to analyze the related factors affecting natural delivery in pregnant women with HDCP.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of AOP,HPD,and HSD for the delivery mode of pregnant women with HDCP.The differences of ultrasonographic characteristics of the second stage of labor among different delivery methods and different pregnancy outcomes were compared.Results A total of 67 women had natural delivery,15 women had assisted delivery,and 24 women converted to cesarean section.The AOP of the midwifery or cesarean section group was lower than that of the natural delivery group[(102±9)° vs(138±14)°],and the HPD and HSD were higher than those of the natural delivery group[(5.6±1.4)cm vs(3.1±0.6)cm,(2.52±0.42)cm vs(1.21±0.26)cm](all P＜0.05).The prolonged duration of the second stage of labor,large HPD and large HSD were risk factors for midwifery or cesarean section,and large AOP was a protective factor for natural delivery in pregnant women with HDCP(all P＜0.05).The critical values of AOP,HPD,and HSD in predicting the delivery mode of HDCP pregnant women were 125°,4 cm,and 1.5 cm,respec-tively,and the area under the curve was 0.780,0.761,and 0.744,respectively.The area under the curve of the combined prediction of the three was 0.915,which was greater than that of the individual prediction(all P＜0.05).The natural delivery rate of AOP＜125° group,HPD ≥4 cm group and HSD≥ 1.5 cm group was lower than that of AOP≥125° group,HPD＜4 cm group and HSD＜1.5 cm group,respectively(all P＜0.05).There were 12 cases of adverse pregnancy outcomes.The AOP of the poor pregnancy outcome group was lower than that of the good pregnancy outcome group,and the HPD and HSD were higher than that of the good pregnancy outcome group(all P＜0.05).Conclusion The reduce of AOP and the increase of HPD and HSD during the second stage of labor are related to the midwifery or cesarean section and adverse pregnancy outcomes of HDCP pregnant women.The combination of AOP,HPD and HSD can effectively predict the delivery mode of HDCP pregnant women.