WO2022025062A1 - Dispositif d'évaluation d'état d'avancement du travail, procédé d'évaluation d'état d'avancement du travail et programme - Google Patents

Dispositif d'évaluation d'état d'avancement du travail, procédé d'évaluation d'état d'avancement du travail et programme Download PDF

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Publication number
WO2022025062A1
WO2022025062A1 PCT/JP2021/027748 JP2021027748W WO2022025062A1 WO 2022025062 A1 WO2022025062 A1 WO 2022025062A1 JP 2021027748 W JP2021027748 W JP 2021027748W WO 2022025062 A1 WO2022025062 A1 WO 2022025062A1
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straight line
angle
pubis
display unit
unit
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PCT/JP2021/027748
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English (en)
Japanese (ja)
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高行 入山
絵里子 矢野
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国立大学法人東京大学
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Priority to JP2022539498A priority Critical patent/JP7501935B2/ja
Publication of WO2022025062A1 publication Critical patent/WO2022025062A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/13—Tomography
    • A61B8/14—Echo-tomography

Definitions

  • the present invention relates to a delivery progress evaluation device, a delivery progress evaluation method and a program.
  • Non-Patent Document 1 As a technique related to transperineal ultrasonography during delivery, there is a technique for measuring the pelvic angle of a pregnant woman in the third trimester of pregnancy based on CT images (for example, Non-Patent Document 1).
  • the first is called "station". It uses the advanced part of the fetal head to indicate the degree of descent of the fetal head. That is, it is considered that the station when the tip of the baby's head reaches the level of the ischial spine of the mother is set to 0, and at this time, the baby's head has invaded the pelvic brim.
  • the stations are set to +5, +4, +3, +2, +1, 0, -1, -2, -3, -4, -5 according to the degree of descent of the baby's head.
  • the station is an index for determining the delivery method when an urgent delivery is required. That is, if the station value is larger than a certain value (that is, if the baby's head is below the position), vaginal delivery can be safely performed by forceps / suction delivery, or if the station value is smaller than a certain value (that is, if the station value is smaller than a certain value). That is, if the baby's head is above a certain position), it can be judged that forceps / suction delivery is dangerous to the baby and therefore a caesarean section is necessary in principle.
  • FIG. 1 is a view of a human bone birth canal from the left side of the body.
  • the area of the bone birth canal is anatomically classified as merkmal at the inferior pubic margin, midpoint of the pubis, ischial spine, tip of the sacrum, and second / third sacral fusion.
  • the bone birth canal is described as an entrance surface, a high presence, a high middle presence, a low middle presence, a low presence, and an exit portion in order from the top.
  • the straight line L1 is a straight line connecting the lower edge of the pubic symphysis and the tip of the sacrum, and forms a boundary between the low position and the exit portion.
  • the straight line L3 is a straight line connecting the midpoint of the posterior surface of the pubic symphysis and the second / third sacral fusion site, and forms the boundary between high and low midpoint. As the delivery progresses, the fetal head descends from the entrance surface toward the exit part of the bone birth canal.
  • Doctors and midwives grasp the positional relationship between the maximum passage surface of the baby's head and the pelvis by pelvic examination, and evaluate the progress of delivery according to the position of the maximum passage surface in the birth canal.
  • the maximum passage surface of the baby's head is located in the bone birth canal is an index for determining the delivery method in an emergency. That is, if the maximum passage surface is located below the low position, it is possible to safely deliver vaginal delivery by forceps / suction delivery in an emergency, or if it is located above the high level, a caesarean section is required. If it is located, it is possible to make a judgment such as the judgment of the person in charge of delivery and the selection of the delivery method according to the technique.
  • pelvic examination in general, it is difficult to learn the evaluation by the above-mentioned pelvic examination, and it depends on the individual skill and experience. For this reason, there is a problem that accuracy and objectivity are lacking only by pelvic examination. In particular, since pelvic examination cannot be visualized, safety and accuracy cannot be objectively evaluated.
  • Angle of Assessment is one of the parameters for evaluating the descent of the fetal head in the transperineal ultrasound method. AoP is defined as the angle between the straight line connecting the upper and lower pubic edges and the tangent line drawn from the lower end of the pubis to the tip of the fetal head.
  • Non-Patent Document 1 The technique described in Non-Patent Document 1 is for pregnant women (458 people) in the third half of pregnancy in France, a straight line passing through the upper end of the pubis and the lower end of the pubis and a straight line passing through the lower end of the pubis and the midpoint of the ischial spine (described above).
  • This measurement gave a result of 110 °.
  • This result provides an anatomical index that can be applied as one of the criteria for transperineal ultrasonography.
  • Non-Patent Document 1 "the angle between the straight line passing through the upper end of the pubis and the lower end of the pubis and the straight line corresponding to the above-mentioned straight line L1" and “the straight line passing between the upper end of the pubis and the lower end of the pubis and the above-mentioned straight line L3". No results have been obtained for the "angle formed by the corresponding straight line”. That is, the technique described in Non-Patent Document 1 does not sufficiently clarify the angle that defines the classification of the bone birth canal region. In this respect, it cannot be said that the technique is sufficient as a technique for evaluating the progress of labor using the maximum passage surface.
  • the present invention has been made in view of such a situation, and an object thereof is to identify and visualize a region in the bone birth canal on an ultrasonic image.
  • the delivery progress evaluation device has a display unit for displaying an ultrasonic image of the bone birth canal during delivery, and the positions of the upper and lower ends of the sham bone displayed on the display unit.
  • the first straight line passing through the lower end of the sciatic bone and the tip of the sacral bone on the ultrasonic image displayed on the position acquisition unit and the display unit.
  • the first straight line formed by the angle formed by the connecting straight line is the first angle, and the second straight line passing through the lower end of the sciatic bone and the midpoint of the sciatic spine.
  • a second straight line whose angle formed with the straight line connecting the two is the second angle, and a third straight line passing through the midpoint of the sciatic bone and the second / third sacral fusion site, and the third straight line.
  • a straight line drawing unit for drawing a third straight line whose angle formed by the straight line connecting the upper end and the lower end of the shambone is the third angle is provided.
  • the first angle may be 109 ° or more and 123 ° or less
  • the second angle may be 103 ° or more and 115 ° or less
  • the third angle may be 94 ° or more and 108 ° or less.
  • Another aspect of the present invention is also a delivery progress evaluation device.
  • This device has a display unit that displays an ultrasonic image of the bone birth canal during delivery, a position acquisition unit that acquires the positions of the upper and lower ends of the sham bone displayed on the display unit, and an ultrasonic image displayed on the display unit.
  • a first straight line extending linearly from the lower end of the sham bone toward the bone birth canal
  • a second straight line extending linearly from the lower end of the sham bone toward the bone birth canal
  • a bone birth canal from the midpoint of the sham bone.
  • a straight line drawing part that draws a third straight line extending linearly in a direction, a first angle that is an angle formed by a straight line connecting the first straight line and the upper end and the lower end of the shambone, and a first angle.
  • the second angle which is the angle between the straight line 2 and the straight line connecting the upper and lower ends of the shambone
  • the third angle which is the angle between the third straight line and the straight line connecting the upper and lower ends of the shambone. It is provided with a rewritable angle information storage unit for storing an angle.
  • the angle information storage unit stores 109 ° or more and 123 ° or less as the initial value of the first angle, 103 ° or more and 115 ° or less as the initial value of the second angle, and as the initial value of the third angle. Stores 94 ° or more and 108 ° or less.
  • the delivery progress evaluation device may include a position input unit for the user to input the positions of the upper end and the lower end of the pubis.
  • the position acquisition unit may acquire the positions of the upper end and the lower end of the pubis input to the position input unit.
  • the delivery progress evaluation device may include an image recognition unit that recognizes the positions of the upper and lower ends of the pubis from the image of the bone birth canal displayed on the display unit.
  • the position acquisition unit may acquire the positions of the upper end and the lower end of the pubis recognized by the image recognition unit.
  • the image recognition unit may learn the positions of the upper and lower ends of the pubis by machine learning.
  • the display unit may display each bone birth canal region defined by the first straight line, the second straight line, and the third straight line.
  • the straight line drawing unit may draw a tangent line drawn from the lower end of the pubis to the tip of the baby's head displayed on the display unit.
  • the delivery progress assessor draws a tangent line from the lower end of the pubis to the tip of the fetal head when it reaches either the first straight line, the second straight line, or the third straight line.
  • a notification unit for notifying the user may be provided.
  • the straight line drawing unit may draw a cut end in which the maximum passing surface of the baby's head is cut by a plane parallel to the display surface.
  • the straight line drawing unit may draw the center point in the baby's head at the cut end in which the maximum passing surface of the baby's head is cut by a plane parallel to the display plane.
  • the delivery progress assessor measures a fourth angle, which is the angle between the straight line connecting the upper and lower ends of the pubis and the straight line connecting the lower end of the pubis and the aforementioned center point.
  • the angle measuring unit may be provided.
  • the delivery progress evaluation device may include a first angle change rate calculation unit for calculating the time change rate of the fourth angle.
  • the delivery progress evaluation device may include a first angle change rate display unit that displays the time change rate of the fourth angle as a function of time.
  • the delivery progress evaluation device may include a first warning unit that warns the user when the time change rate of the fourth angle becomes smaller than a predetermined value.
  • the delivery progress assessor measures a fifth angle, which is the angle between the straight line connecting the upper and lower ends of the pubis and the tangent drawn from the lower end of the pubis to the tip of the baby's head.
  • the angle measuring unit may be provided.
  • the delivery progress evaluation device may include a second angle change rate calculation unit that calculates the time change rate of the fifth angle.
  • the delivery progress evaluation device may include a second angle change rate display unit that displays the time change rate of the fifth angle as a function of time.
  • the delivery progress assessor is an angle formed by a straight line connecting the upper and lower ends of the pubic bone and a cut cut from the maximum passage surface of the baby's head in a plane parallel to the display surface of the display unit.
  • a third angle measuring unit may be provided for measuring the sixth angle.
  • the delivery progress evaluation device may include a third angle change rate calculation unit that calculates the time change rate of the sixth angle.
  • the delivery progress evaluation device may include a third angle change rate display unit that displays the time change rate of the sixth angle as a function of time.
  • the delivery progress assessor comprises a second warning unit that warns the user when the ratio of the sixth angle to the fifth angle is less than a predetermined value. May be good.
  • Yet another aspect of the present invention is also a delivery progress evaluation device.
  • This device has a display unit that displays an ultrasonic image of the bone birth canal during delivery, a position acquisition unit that acquires the positions of the upper and lower ends of the sham bone displayed on the display unit, and an ultrasonic image displayed on the display unit.
  • a display unit that displays an ultrasonic image of the bone birth canal during delivery
  • a position acquisition unit that acquires the positions of the upper and lower ends of the sham bone displayed on the display unit
  • an ultrasonic image displayed on the display unit Above, it is the first straight line passing through the lower end of the sciatic bone and the tip of the sacral bone, and the angle formed by the first straight line and the straight line connecting the upper end and the lower end of the scrotum is the first straight line.
  • a second straight line passing through the lower end of the sciatic bone and the midpoint of the sciatic spine, and the angle formed by the second straight line and the straight line connecting the upper end and the lower end of the sciatic bone is the second straight line.
  • a third straight line passing through the midpoint of the scrotum and the second / third sacral fusion, and the angle between the third straight line and the straight line connecting the upper and lower ends of the sciatic bone is the third angle. It is provided with a straight line drawing unit for drawing at least one of the third straight lines.
  • Yet another aspect of the present invention is also a delivery progress evaluation device.
  • This device passes through a display unit that displays an ultrasonic image of the bone birth canal during delivery, a position acquisition unit that acquires the positions of the upper and lower ends of the shambone displayed on the display unit, and the lower end of the shambone and the tip of the sacral bone. It passes through the first angle calculation unit that calculates the angle between the first straight line and the straight line connecting the upper end and the lower end of the sciatic bone, and the lower end of the sciatic bone and the midpoint of the sciatic spine.
  • a second angle calculation unit that calculates the angle between the second straight line and the straight line connecting the upper end and the lower end of the scrotum, the midpoint of the shambone, and the second / third.
  • a third angle calculation unit for calculating the angle formed by a third straight line passing through the sacral fusion portion and a straight line connecting the upper end and the lower end of the sciatic bone, and a display unit.
  • a tangent drawing unit for drawing a tangent line drawn from the lower end of the shambone to the tip of the baby's head is provided on the displayed ultrasonic image.
  • Yet another aspect of the present invention is also a delivery progress evaluation device.
  • This device passes through a display unit that displays an ultrasonic image of the bone birth canal during delivery, a position acquisition unit that acquires the positions of the upper and lower ends of the shambone displayed on the display unit, and the lower end of the shambone and the tip of the sacral bone. It passes through the first angle calculation unit that calculates the angle between the first straight line and the straight line connecting the upper end and the lower end of the sciatic bone, and the lower end of the sciatic bone and the midpoint of the sciatic spine.
  • a second angle calculation unit that calculates the angle between the second straight line and the straight line connecting the upper end and the lower end of the scrotum, the midpoint of the shambone, and the second / third.
  • a third angle calculation unit for calculating the angle formed by a third straight line passing through the sacral fusion portion and a straight line connecting the upper end and the lower end of the sciatic bone, and a display unit.
  • a cut edge drawing unit for drawing a cut edge in which the maximum passing surface of the baby's head is cut by a plane parallel to the display surface is provided.
  • Yet another aspect of the present invention is also a delivery progress evaluation device.
  • This device passes through a display unit that displays an ultrasonic image of the bone birth canal during delivery, a position acquisition unit that acquires the positions of the upper and lower ends of the shambone displayed on the display unit, and the lower end of the shambone and the tip of the sacral bone. It passes through the first angle calculation unit that calculates the angle between the first straight line and the straight line connecting the upper end and the lower end of the sciatic bone, and the lower end of the sciatic bone and the midpoint of the sciatic spine.
  • a second angle calculation unit that calculates the angle between the second straight line and the straight line connecting the upper end and the lower end of the scrotum, the midpoint of the shambone, and the second / third.
  • a third angle calculation unit for calculating the angle formed by a third straight line passing through the sacral fusion portion and a straight line connecting the upper end and the lower end of the sciatic bone, and a display unit.
  • a center point drawing unit for drawing the center point in the baby's head at the cut end obtained by cutting the maximum passing surface of the baby's head with a plane parallel to the display plane is provided.
  • Yet another aspect of the present invention is a method for evaluating the progress of labor.
  • a step of acquiring an ultrasonic image of the bone birth canal during delivery a step of displaying the acquired ultrasonic image on the display unit, and a step of acquiring the positions of the upper end and the lower end of the pubis displayed on the display unit.
  • the angle between the first straight line passing through the lower end of the pubis and the tip of the pubis and the straight line connecting the upper and lower ends of the pubis on the ultrasonic image displayed on the display unit. Is the first straight angle, which is the first angle, and the second straight line passing through the lower end of the pubis and the midpoint of the pubic spine.
  • Yet another aspect of the present invention is a program.
  • This program has a step of acquiring an ultrasonic image of the bone birth canal during delivery, a step of displaying the acquired ultrasonic image on the display unit, and a step of acquiring the positions of the upper and lower ends of the sham bone displayed on the display unit.
  • the angle formed by the first straight line passing through the lower end of the sciatic bone and the tip of the sacral bone, and the straight line connecting the upper end and the lower end of the skeletal bone. Is the first straight line, which is the first angle, and the second straight line passing through the lower end of the sciatic bone and the midpoint of the sciatic spine.
  • FIGS. 2 and 1 The angle formed by the straight line passing through the upper end of the pubis and the lower end of the pubis and the straight line passing through the midpoint of the pubis and the second / third sacral fusion portion (corresponding to the above-mentioned straight line L3).
  • the measurement results are shown in FIGS. 2 and 1 (note that FIG. 2 is a view of the bone birth canal from the right side of the body, contrary to FIG. 1).
  • Table 1 [114.2 ° -117.4 °] and the like indicate the range of values obtained by actual measurement. Further, 115.9 ° ⁇ 6.5 ° and the like indicate an average value ⁇ 1.96 ⁇ standard deviation (confidence interval 95%).
  • (B) corresponds to the result disclosed in Non-Patent Document 1.
  • (a) and (b) are the values obtained by these researchers for the first time in the world.
  • no correlation was found with the age, height, and transvaginal delivery history of the pregnant women used as samples. Therefore, these results are considered to be universal for all pregnant women.
  • the measurement result of (b) is almost the same as the measurement result (110 °) obtained in Non-Patent Document 1. Therefore, this is considered to be an absolute merkmal regardless of race.
  • a straight line L1 can be drawn from the measurement result of (a), and the boundary between the low presence of the bone birth canal and the exit portion can be defined.
  • a straight line L2 can be drawn from the measurement result of (b), and the boundary between the low presence and the low presence of the bone birth canal can be defined.
  • a straight line L3 can be drawn from the measurement result of (c), and the boundary between the high and low vagina of the bone birth canal can be defined. Therefore, these measurement results can define the classification of the bone birth canal region necessary for the evaluation of the progress of labor using transperineal ultrasound.
  • FIG. 3 is a functional block diagram of the delivery progress evaluation device 1.
  • the delivery progress evaluation device 1 includes a display unit 10, a position acquisition unit 20, and a linear drawing unit 30.
  • the display unit 10 is a display for displaying an image, and may be any suitable display such as a liquid crystal display, a video projector, or a head-mounted display.
  • the display unit 10 displays an ultrasonic image of the bone birth canal during delivery. This ultrasound image is obtained, for example, by applying an ultrasound probe to the perineum of a pregnant woman.
  • FIG. 4 is an ultrasonic image displayed on the display unit 10.
  • This ultrasound image shows the bone birth canal seen from the right side of the mother's body, with the upper part facing the screen on the ventral side, the lower part on the back side, the left side on the head side, and the right side on the foot side.
  • the maternal pubis is shown above this ultrasound image, and the fetal head is shown in the large area below.
  • the position acquisition unit 20 acquires the positions of the upper end and the lower end of the pubis displayed on the display unit 10.
  • the positions of the upper end and the lower end of the pubis may be visually determined by the user while observing the ultrasonic image displayed on the display unit 10, or the image recognition device may determine the position based on the ultrasonic image displayed on the display unit 10. May be automatically recognized.
  • FIG. 5 shows the upper end and the lower end of the pubis acquired by the position acquisition unit 20 in the ultrasonic image displayed on the display unit 10.
  • the left end is the upper end and the right end is the lower end when facing the pubic screen.
  • the fetal head depicted on the ultrasound image tends to be unclear, especially on the posterior side.
  • the outline of the rear side of the baby's head (lower left side on the screen) is not clear. Therefore, in FIG. 5, the vertical cross section of the fetal head is approximated as an ellipse (the short axis is represented by L5 and the long axis is represented by L6), and this ellipse is drawn (the same applies to the following drawings).
  • Such an elliptical approximation may be performed visually by the user while observing the ultrasonic image displayed on the display unit 10, or the image recognition device automatically performs such an elliptical approximation based on the ultrasonic image displayed on the display unit 10. You may go or combine them.
  • the straight line drawing unit 30 draws a first straight line L1, a second straight line L2, and a third straight line L3 on the ultrasonic image displayed on the display unit 10.
  • L0 be a straight line passing through the upper end and the lower end of the pubis.
  • the first straight line L1 is a straight line passing through the lower end of the pubis and the tip of the sacrum.
  • the angle formed by the first straight line L1 and the straight line L0 is defined as the first angle ⁇ 1.
  • the second straight line L2 is a straight line passing through the lower end of the pubis and the midpoint of the ischial spine.
  • the angle formed by the second straight line L2 and the straight line L0 is defined as the second angle ⁇ 2.
  • the third straight line L3 is a straight line passing through the midpoint of the pubis and the second / third sacral fusion site.
  • the angle formed by the third straight line L3 and the straight line L0 is defined as the third angle ⁇ 3.
  • FIG. 6 shows the first, second and third straight lines L1, L2 and L3 drawn by the straight line drawing unit 30 on the ultrasonic image of FIG.
  • the first straight line L1 defines the boundary between the low presence of the bone birth canal and the exit portion.
  • the second straight line L2 defines the boundary between low vaginal and low vaginal birth canal.
  • the third straight line L3 defines the boundary between the high and low vagina of the bone birth canal. Therefore, these three straight lines can visualize the classification of the bone birth canal region necessary for the evaluation of the progress of labor using transperineal ultrasound on the ultrasound screen. This allows doctors and midwives to evaluate the progress of labor while visually confirming the positional relationship between the fetal head and the bone birth canal region. Especially when it is necessary to determine the delivery policy in an emergency, it is possible to select an accurate and objectively appropriate delivery method.
  • the straight line drawing unit 30 does not necessarily have to draw all of the first straight line, the second straight line, and the third straight line.
  • the straight line drawing unit 30 may draw at least one of a first straight line, a second straight line, and a third straight line.
  • the maximum passage surface is in the high-middle position or the low-middle position.
  • a third straight line the boundary line between high and low middle
  • the maximum passage surface is in the high-middle or low-middle position for a skilled doctor (ie, capable of forceps delivery in the low-middle position). It is important whether it is located in. In this case, if the third straight line is drawn, it can be determined that the maximum passage surface is not located in the high middle position, and it is extremely useful because it is known that forceps delivery can be performed. Also, if the second straight line (the boundary line between low and low presence) is drawn, it can be determined that the maximum passage surface is not low, and it is also useful because it can be seen that it will be difficult forceps delivery. be.
  • the maximum passage surface is in the low-middle or low position. It is important to do it.
  • the second straight line is drawn, it can be determined that the maximum passage surface is not in a low position, so that it is difficult to deliver forceps, and it is extremely useful because a caesarean section can be selected. ..
  • the third straight line is drawn, it can be determined that the maximum passage surface is not located in the high middle position, and it is also useful because it is understood that forceps delivery is an option.
  • the first angle ⁇ 1 is 109 ° or more and 123 ° or less
  • the second angle ⁇ 2 is 103 ° or more and 115 ° or less
  • the third angle ⁇ 3 is 94 ° or more and 108 ° or less. ..
  • these angle values are the world's first indicators identified by the present inventors using the measurement of each merkmal on the pelvic MRI of a pregnant woman.
  • the first, second and third straight lines L1, L2 and the straight line L3 can be drawn by defining specific numerical values. The above numerical range is included in the 95% confidence interval centered on the average value obtained by the measurement.
  • the display unit 10 may display each bone birth canal region defined by the first straight line L1, the second straight line L2, and the third straight line L3.
  • FIG. 7 shows a bone birth canal region drawn by the display unit 10 on the ultrasonic image of FIG.
  • the center point P0 in the fetal head is drawn.
  • the center point P0 provides useful information for intuitively grasping the trajectory through which the maximum passage surface of the baby's head passes. Therefore, by drawing the center point P0 in this way, information on the positional relationship between the maximum passage surface of the baby's head and each region of the bone birth canal can be obtained, and the usability of the user is further improved.
  • FIG. 8 is a functional block diagram of the delivery progress evaluation device 2 according to the second embodiment.
  • the delivery progress evaluation device 2 includes a display unit 10, a position acquisition unit 20, a linear drawing unit 30, and an angle information storage unit 40. That is, the delivery progress evaluation device 2 includes an angle information storage unit 40 in addition to the configuration of the delivery progress evaluation device 1 of FIG. Since the other configurations of the delivery progress evaluation device 2 are common to the configurations of the delivery progress evaluation device 1, duplicated explanations will be omitted.
  • the angle information storage unit 40 is composed of a rewritable storage medium, and stores the first angle ⁇ 1, the second angle ⁇ 2, and the third angle ⁇ 3 as angle information. That is, the angle information storage unit 40 can store the initial values of the first, second, and third angles ⁇ 1, ⁇ 2, and ⁇ 3 in the initial state, and can rewrite the values of these angles as appropriate thereafter.
  • the straight line drawing unit 30 reads out the first, second and third angles ⁇ 1, ⁇ 2 and ⁇ 3 stored in the angle information storage unit 40, and based on these values, the first, second and third straight lines. L1, L2 and L3 are drawn.
  • the angle information storage unit 40 stores 109 ° or more and 123 ° or less as the initial value of the first angle ⁇ 1, and 103 ° or more and 115 ° or less as the initial value of the second angle ⁇ 2. Then, 94 ° or more and 108 ° or less are stored as the initial value of the third angle ⁇ 3. Then, when more appropriate angle information is obtained by new measurement or the like, these angle information is rewritten.
  • the delivery progress assessment device 2 may include an angle database accumulating data on the first, second and third angles ⁇ 1, ⁇ 2 and ⁇ 3 according to race.
  • the angle information storage unit 40 stores the initial values of the first angle ⁇ 1, the second angle ⁇ 2, and the third angle ⁇ 3, and then acquires the angle data according to the race from the above-mentioned angle database.
  • the initial value may be changed. According to the present embodiment, even when the first, second and third angles ⁇ 1, ⁇ 2 and ⁇ 3 differ between races, the progress of labor is evaluated based on an accurate initial value. Can be done.
  • FIG. 9 is a functional block diagram of the delivery progress evaluation device 3 according to the third embodiment.
  • the delivery progress evaluation device 3 includes a position input unit 50 in addition to the configuration of the delivery progress evaluation device 1 of FIG. Since the other configurations of the delivery progress evaluation device 3 are common to the configurations of the delivery progress evaluation device 1, duplicated explanations will be omitted.
  • the position input unit 50 is for the user to input the positions of the upper end and the lower end of the pubis.
  • the position input unit 50 may be any suitable input interface such as a touch panel, a mouse, and a keyboard.
  • the position acquisition unit 20 acquires the positions of the upper end and the lower end of the pubis input to the position input unit 50.
  • the user can visually determine the positions of the upper end and the lower end of the pubis while observing the ultrasonic image displayed on the display unit 10, and input this to the position input unit 50. can.
  • FIG. 10 is a functional block diagram of the delivery progress evaluation device 4 according to the fourth embodiment.
  • the delivery progress evaluation device 4 includes an image recognition unit 60 in addition to the configuration of the delivery progress evaluation device 1 of FIG. Since the other configurations of the delivery progress evaluation device 4 are common to the configurations of the delivery progress evaluation device 1, duplicate explanations will be omitted.
  • the image recognition unit 60 recognizes the positions of the upper end and the lower end of the pubis from the image of the bone birth canal displayed on the display unit 10.
  • the image recognition unit 60 may use known image recognition software to identify the pubis from the ultrasonic image of the bone birth canal and recognize the upper end and the lower end thereof.
  • the position acquisition unit 20 acquires the positions of the upper end and the lower end of the pubis recognized by the image recognition unit 60.
  • the positions of the upper end and the lower end of the pubis can be automatically acquired without the user visually determining and inputting the positions.
  • the image recognition unit 60 may learn the positions of the upper end and the lower end of the pubis by machine learning. Learning may be done by a known AI.
  • the specific method of AI is not particularly limited, but for example, a convolutional neural network (CNN), a recurrent neural network (RNN), an LSTM network (Long Short Term Memory) ST, etc.
  • CNN convolutional neural network
  • RNN recurrent neural network
  • LSTM Long Short Term Memory
  • the straight line drawing unit 30 draws a tangent line drawn from the lower end of the pubis to the tip of the fetal head.
  • FIG. 11 shows the tangent line L4 drawn from the lower end of the pubis to the tip of the fetal head in the displayed ultrasonic image.
  • FIG. 12 is a functional block diagram of the delivery progress evaluation device 5 according to the sixth embodiment.
  • the delivery progress evaluation device 5 includes a notification unit 70 in addition to the configuration of the delivery progress evaluation device 1 of FIG.
  • the straight line drawing unit 30 draws a tangent line drawn from the lower end of the pubis to the tip of the fetal head in addition to the first, second and third straight lines L1, L2 and L3. Since the other configurations of the delivery progress evaluation device 5 are common to the configurations of the delivery progress evaluation device 1, duplicated explanations will be omitted.
  • the notification unit 70 notifies the user when the tangent line drawn from the lower end of the pubis to the tip of the fetal head reaches any of the first straight line L1, the second straight line L2, and the third straight line L3.
  • the notification method may be any suitable method such as lighting of a lamp, notification sound, vibration of a vibrator, blinking of the display unit 10, and change of color. According to the present embodiment, when the fetal head moves from one area in the bone birth canal to another area, the user can be notified of this, so that the usability and safety of the user are further improved.
  • the straight line drawing unit 30 draws a cut end obtained by cutting the maximum passing surface of the fetal head with a plane parallel to the display surface of the display unit 10.
  • the display surface is a surface on which an image is displayed on the display unit 10.
  • the display unit 10 is a liquid crystal display, it is the surface of the display.
  • FIG. 13 shows a cut L5 in which the maximum passing surface of the baby's head is cut by a plane parallel to the display surface of the display unit 10 in the displayed ultrasonic image.
  • the maximum passage surface is the cross section of the fetal head having the largest peripheral diameter in the bone birth canal.
  • the maximum passage surface may be considered to be a cross section including the elliptical short axis L5. That is, the cut end L5 obtained by cutting the maximum passage surface of the fetal head with a plane parallel to the display surface of the display unit 10 coincides with the minor axis L5 of the ellipse.
  • the linear drawing unit 30 draws the center point in the child's head at the cut end in which the maximum passing surface of the baby's head is cut by a plane parallel to the display surface of the display unit 10.
  • FIG. 14 shows a center point P0 in the baby's head at the cut end L5 in which the maximum passing surface of the baby's head is cut by a plane parallel to the display surface of the display unit 10.
  • the center point P0 is the midpoint between the two intersections P1 and P2 of the cut L5 and the contour line of the fetal head.
  • the center P0 coincides with the intersection of the short axis L5 and the long axis L6.
  • the center point P0 does not indicate the maximum passing surface itself, but it can provide useful information for intuitively determining the locus through which the maximum passing surface passes.
  • the cut end L5 has aspects such as the degree of scale does not match the display indicating the boundary line of the pelvis, and errors in drawing are likely to occur. Therefore, in clinical use, the center point P0 may be easier to use. .. By drawing the center point P0 in this way, information on the positional relationship between the maximum passage surface of the baby's head and each region of the bone birth canal can be obtained, so that the usability of the user is further improved.
  • FIG. 15 is a functional block diagram of the delivery progress evaluation device 6 according to the ninth embodiment.
  • the delivery progress evaluation device 6 includes an angle measuring unit 80 in addition to the configuration of the delivery progress evaluation device 1 of FIG. Since the other configurations of the delivery progress evaluation device 6 are common to the configurations of the delivery progress evaluation device 1, duplicated explanations will be omitted.
  • the angle measuring unit 80 measures a fourth angle, which is an angle formed by a straight line connecting the upper end and the lower end of the pubis and a straight line connecting the lower end of the pubis and the above-mentioned center point.
  • FIG. 16 shows the angle ⁇ 4 between the straight line L0 connecting the upper end and the lower end of the pubis and the straight line L7 connecting the lower end of the pubis and the center point P0.
  • the angle measuring unit 80 may specify the lower end of the pubis and the center point P0 and calculate the angle ⁇ 4 by using known image recognition software.
  • the angle ⁇ 4 is considered to be a numerical value that quantitatively indicates the position of the maximum passage surface of the baby's head in the bone birth canal. Therefore, according to the present embodiment, the user can quantitatively evaluate the progress of delivery based on the position of the maximum passage surface of the baby's head.
  • FIG. 19 is a functional block diagram of the delivery progress evaluation device 7 according to the tenth embodiment.
  • the delivery progress evaluation device 7 includes an angle change rate calculation unit 90 in addition to the configuration of the delivery progress evaluation device 6 of FIG. Since the other configurations of the delivery progress evaluation device 7 are common to the configurations of the delivery progress evaluation device 6, duplicate explanations will be omitted.
  • the angle change rate calculation unit 90 calculates the time change rate of the fourth angle ⁇ 4. As described above, since the angle ⁇ 4 indicates the position of the maximum passage surface of the baby's head in the bone birth canal, the time change rate of the angle ⁇ 4 is considered to be a numerical value that quantitatively indicates the velocity of the maximum passage surface in the bone birth canal. .. Therefore, according to the present embodiment, the user can quantitatively evaluate the progress of delivery based on the velocity of the maximum passage surface of the baby's head.
  • FIG. 20 is a functional block diagram of the delivery progress evaluation device 8 according to the eleventh embodiment.
  • the delivery progress evaluation device 8 includes an angle change rate display unit 92 in addition to the configuration of the delivery progress evaluation device 7 of FIG. Since the other configurations of the delivery progress evaluation device 8 are common to the configurations of the delivery progress evaluation device 7, duplicate explanations will be omitted.
  • the angle change rate display unit 92 displays the time change rate of the fourth angle described above as a function of time.
  • the display may be made by any suitable method such as numbers, line graphs, and histograms. According to the present embodiment, the user can visually recognize the speed of the maximum passage surface of the baby's head, so that the progress of delivery can be evaluated in real time.
  • FIG. 21 is a functional block diagram of the delivery progress evaluation device 9 according to the twelfth embodiment.
  • the delivery progress evaluation device 9 includes a warning unit 94 in addition to the configuration of the delivery progress evaluation device 7 of FIG. Since the other configurations of the delivery progress evaluation device 9 are common to the configurations of the delivery progress evaluation device 7, duplicate explanations will be omitted.
  • the warning unit 94 warns the user when the time change rate of the fourth angle ⁇ 4 described above becomes smaller than a predetermined value. As described above, the time change rate of the angle ⁇ 4 indicates the velocity of the maximum passage surface of the baby's head in the bone birth canal.
  • the safety of delivery can be further enhanced.
  • the angle measuring unit 80 of the delivery progress evaluation device 6 of FIG. 15 is an angle formed by a straight line connecting the upper end and the lower end of the pubis and a tangent line drawn from the lower end of the pubis to the tip of the baby's head. Measure the fifth angle.
  • FIG. 17 shows the angle ⁇ 5 between the straight line L0 connecting the upper end and the lower end of the pubis and the tangent line L4 drawn from the lower end of the pubis to the tip of the fetal head.
  • the angle ⁇ 5 is AoP (Angle of Assessment), which is one of the parameters for evaluating the descent of the fetal head.
  • the angle measuring unit 80 may specify the lower end of the pubis and the center point P0 and calculate the angle ⁇ 5 by using known image recognition software. According to this embodiment, the user can quantitatively evaluate the progress of labor based on AoP.
  • the angle measuring unit 80 of the delivery progress evaluation device 6 of FIG. 15 has a straight line connecting the upper end and the lower end of the pubic bone and a plane parallel to the display surface of the display unit on the maximum passage surface of the baby's head.
  • the sixth angle which is the angle formed by the cut end, is measured.
  • FIG. 17 shows the angle ⁇ 6 between the straight line L0 connecting the upper end and the lower end of the pubis and the cut end L5 obtained by cutting the maximum passage surface of the fetal head with a plane parallel to the display surface of the display unit.
  • the cut L5 coincides with the short axis of the ellipse.
  • the sixth angle ⁇ 6 will be described with reference to FIG.
  • the angle HD of the angle formed by the straight perpendicular line L8 connecting the upper end and the lower end of the pubis and the direction in which the baby's head travels is known as Head Direction.
  • the angle HD and the angle ⁇ 6 are equal to each other. That is, the sixth angle ⁇ 6 represents Head Direction (hereinafter referred to as “HD”).
  • HD tends to be smaller than AoP.
  • the absolute value of HD increases as delivery progresses (AoP increases). Therefore, it is especially important to evaluate the ratio of HD to AoP in order to notice abnormal rotation.
  • the sixth angle ⁇ 6 (HD) is defined as that shown in FIG.
  • HD is defined as an angle obtained by subtracting 90 ° from the above-mentioned sixth angle ⁇ 6.
  • which of these angles HD is defined is not uniquely determined by academic societies. Needless to say, these differences are merely definitional differences and are clinically equivalent. Therefore, it should be noted that the present embodiment holds exactly the same even when HD is defined by the above-mentioned sixth angle ⁇ 6 minus 90 °.
  • the present embodiment it is possible to detect a rotation abnormality by knowing the HD value. Therefore, when urgent delivery is required, it is possible to determine a safe delivery method regarding whether suction delivery or forceps delivery is possible. This makes it possible to further enhance the safety of delivery.
  • the angle change rate calculation unit 90 in FIG. 19 calculates the time change rate of the fifth angle ⁇ 5. Since the angle ⁇ 5 indicates AoP as described above, the time change rate of the angle ⁇ 5 is considered to be a numerical value that quantitatively indicates the progress rate of labor. Therefore, according to the present embodiment, the user can quantitatively evaluate the progress of labor based on the time change rate of AoP.
  • the angle change rate display unit 92 of FIG. 20 displays the time change rate of the fifth angle ⁇ 5 as a function of time.
  • the display may be made by any suitable method such as numbers, line graphs, and histograms. According to the present embodiment, the user can visually recognize the time change rate of AoP, so that the progress of delivery can be evaluated in real time.
  • the angle change rate calculation unit 90 in FIG. 19 calculates the time change rate of the sixth angle ⁇ 6. Since the angle ⁇ 6 indicates HD as described above, the time change rate of the angle ⁇ 6 is considered to be a numerical value that quantitatively indicates the time change in the vertical direction of the fetal head. Therefore, according to the present embodiment, the user can quantitatively evaluate the progress of delivery based on the time change of the vertical orientation of the fetal head.
  • the angle change rate display unit 92 of FIG. 20 displays the time change rate of the sixth angle ⁇ 6 as a function of time.
  • the display may be made by any suitable method such as numbers, line graphs, and histograms. According to the present embodiment, the user can visually recognize the time change rate of HD, so that the progress of delivery can be evaluated in real time.
  • the warning unit 94 of FIG. 21 warns the user when the ratio of the sixth angle ⁇ 6 to the fifth angle ⁇ 5 becomes smaller than a predetermined value.
  • a specific value is set in advance for the ratio ( ⁇ 6 / ⁇ 5) of the angle ⁇ 6 to the angle ⁇ 5, and when ⁇ 6 / ⁇ 5 becomes smaller than this value during delivery, this is warned to the user. , Risks can be avoided. According to this embodiment, the safety of delivery can be further enhanced.
  • FIG. 22 is a flowchart showing a processing procedure of the delivery progress evaluation method according to the twentieth embodiment.
  • step S1 an ultrasonic image of the bone birth canal during delivery is acquired.
  • This ultrasound image was obtained, for example, by applying an ultrasound probe to the perineum of a pregnant woman.
  • the acquired ultrasonic image is transmitted to the display unit, and the process proceeds to step S2.
  • the ultrasonic image is displayed on the display unit in step S2, and the process proceeds to step S3.
  • step S3 The positions of the upper and lower ends of the pubis in the ultrasonic image displayed on the display unit in step S3 are acquired, and the process proceeds to step S4.
  • step S4 the first straight line, the second straight line, and the third straight line are drawn on the ultrasonic image displayed on the display unit.
  • the first straight line is a straight line passing through the lower end of the pubis and the tip of the sacrum.
  • the angle formed by the first straight line and the straight line connecting the upper end and the lower end of the pubis is the first angle.
  • the second straight line is a straight line passing through the lower end of the pubis and the midpoint of the ischial spine.
  • the angle formed by the second straight line and the straight line connecting the upper end and the lower end of the pubis is the second angle.
  • the third straight line is a straight line passing through the midpoint of the pubis and the second / third sacral fusion site.
  • the angle formed by the third straight line and the straight line connecting the upper end and the lower end of the pubis is the third angle.
  • the first angle may be 109 ° or more and 123 ° or less
  • the second angle may be 103 ° or more and 115 ° or less
  • the third angle may be 94 ° or more and 108 ° or less.
  • the program of the 21st embodiment causes a computer to execute the process described in the 20th embodiment.
  • the straight line drawing unit 30 does not necessarily have to draw the first straight line, the second straight line, or the third straight line, and only draws a tangent line drawn from the lower end of the pubis to the tip of the fetal head. You may draw.
  • the delivery progress evaluation device may include a tangent drawing unit for drawing the above-mentioned tangent line instead of the straight line drawing unit 30.
  • FIG. 23 is a functional block diagram of the delivery progress evaluation device 101 according to the 22nd embodiment.
  • the delivery progress evaluation device 101 includes a display unit 10, a position acquisition unit 20, a first angle calculation unit 111, a second angle calculation unit 112, a third angle calculation unit 113, and a tangent drawing unit 121. And prepare. That is, the delivery progress evaluation device 101 includes a tangential drawing unit 121 instead of the linear drawing unit 30 of the delivery progress evaluation device 1 in FIG. Further, the delivery progress evaluation device 101 adds the first angle calculation unit 111, the second angle calculation unit 112, and the third angle calculation unit 113 to the configuration of the delivery progress evaluation device 1. Be prepared. Since the other configurations of the delivery progress evaluation device 101 are common to the configuration of the delivery progress evaluation device 1, duplicate explanations will be omitted.
  • the first angle calculation unit 111 is a first straight line passing through the lower end of the pubis and the tip of the sacrum, and calculates the angle between the first straight line and the straight line connecting the upper end and the lower end of the pubis. ..
  • the second angle calculation unit 112 is a second straight line passing through the lower end of the pubis and the midpoint of the ischial spine, and determines the angle between the second straight line and the straight line connecting the upper end and the lower end of the pubis. calculate.
  • the third angle calculation unit 113 is a third straight line passing through the midpoint of the pubis and the second / third pubic fusion portion, and is a straight line connecting the third straight line and the upper and lower ends of the pubis. Calculate the angle of the angle to make.
  • the tangent drawing unit 121 draws a tangent line drawn from the lower end of the pubis to the tip of the baby's head on the ultrasonic image displayed on the display unit.
  • the progress of delivery can be evaluated while clearly grasping the positional relationship between the tip of the baby's head and each region of the bone birth canal.
  • the straight line drawing unit 30 does not necessarily have to draw the first straight line, the second straight line, or the third straight line, and the maximum passing surface of the baby head is a plane parallel to the display surface. You may draw only the cut cut in.
  • the delivery progress evaluation device may include a cut edge drawing unit for drawing the above-mentioned cut edge instead of the linear drawing unit 30.
  • FIG. 24 is a functional block diagram of the delivery progress evaluation device 102 according to the 23rd embodiment.
  • the delivery progress evaluation device 102 includes a display unit 10, a position acquisition unit 20, a first angle calculation unit 111, a second angle calculation unit 112, a third angle calculation unit 113, and a cut drawing unit 122. And prepare. That is, the delivery progress evaluation device 102 includes a cut edge drawing unit 122 in place of the tangential drawing unit 121 of the delivery progress evaluation device 101 in FIG. 23. Since the other configurations of the delivery progress evaluation device 102 are common to the configurations of the delivery progress evaluation device 101, duplicate explanations will be omitted.
  • the cut edge drawing unit 122 draws a cut edge on the ultrasonic image displayed on the display unit by cutting the maximum passage surface of the baby's head in a plane parallel to the display surface.
  • the progress of delivery can be evaluated while clearly grasping the positional relationship between the maximum passage surface of the baby's head and each region of the bone birth canal.
  • the straight line drawing unit 30 does not necessarily have to draw the first straight line, the second straight line, or the third straight line, and the maximum passing surface of the fetal head is a plane parallel to the display surface. You may draw only the center point in the fetal head at the cut cut in.
  • the delivery progress evaluation device may include a center point drawing unit for drawing the above-mentioned center point instead of the straight line drawing unit 30.
  • FIG. 25 is a functional block diagram of the delivery progress evaluation device 103 according to the 24th embodiment.
  • the delivery progress evaluation device 103 includes a display unit 10, a position acquisition unit 20, a first angle calculation unit 111, a second angle calculation unit 112, a third angle calculation unit 113, and a center point drawing unit. 123 and. That is, the delivery progress evaluation device 103 includes a center point drawing unit 123 instead of the tangential drawing unit 121 of the delivery progress evaluation device 101 in FIG. 23. Since the other configurations of the delivery progress evaluation device 103 are common to the configurations of the delivery progress evaluation device 101, duplicate explanations will be omitted.
  • the center point drawing unit 123 draws the center point in the child's head at the cut end of the maximum passing surface of the baby's head in a plane parallel to the display surface on the ultrasonic image displayed on the display unit.
  • the progress of delivery can be evaluated while obtaining information on the positional relationship between the maximum passage surface of the baby's head and each region of the bone birth canal.
  • the display unit When displaying each bone birth canal region defined by the first straight line, the second straight line, and the third straight line, the display unit may display each region in a different color. This increases user visibility.
  • the modified example has the same action and effect as the embodiment.
  • the present invention relates to a delivery progress evaluation device, a delivery progress evaluation method and a program.
  • Angle change rate display unit 94 Warning unit 111 ... First angle calculation unit 112 ... Second angle calculation unit 113 ... Third angle calculation unit 121 ... tangent line drawing unit 122 ⁇ ⁇ Cut drawing part 123 ⁇ ⁇ Center point drawing part S1 ⁇ ⁇ Step to acquire an ultrasonic image of the bone birth canal during delivery S2 ⁇ ⁇ Step to display an ultrasonic image on the display part S3 ⁇ ⁇ Displayed on the display part Step to acquire the positions of the upper and lower ends of the pelvic bone S4 ... A step to draw a first straight line, a second straight line, and a third straight line on the ultrasonic image displayed on the display unit.

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Abstract

Un dispositif d'évaluation d'état d'avancement du travail (1) est pourvu : d'une unité d'affichage (10) pour afficher une image ultrasonore de la filière pelvi-génitale osseuse pendant le travail ; d'une unité d'acquisition de position (20) pour acquérir les positions de l'extrémité supérieure et de l'extrémité inférieure de l'os pubien affichées sur l'unité d'affichage (10) ; et d'une unité de traçage de ligne droite (30) pour tracer, sur l'image ultrasonore affichée sur l'unité d'affichage (10), une première ligne droite qui s'étend de l'extrémité inférieure de l'os pubien vers la filière pelvi-génitale osseuse, et forme un premier angle avec une ligne droite reliant l'extrémité supérieure et l'extrémité inférieure de l'os pubien, une deuxième ligne droite qui s'étend de l'extrémité inférieure de l'os pubien vers la filière pelvi-génitale osseuse, et forme un deuxième angle avec la ligne droite reliant l'extrémité supérieure et l'extrémité inférieure de l'os pubien, et une troisième ligne droite qui s'étend depuis le point médian de l'os pubien vers la filière pelvi-génitale osseuse, et forme un troisième angle avec la ligne droite reliant l'extrémité supérieure et l'extrémité inférieure de l'os pubien.
PCT/JP2021/027748 2020-07-28 2021-07-27 Dispositif d'évaluation d'état d'avancement du travail, procédé d'évaluation d'état d'avancement du travail et programme WO2022025062A1 (fr)

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Citations (4)

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Publication number Priority date Publication date Assignee Title
JP2001504380A (ja) * 1997-05-05 2001-04-03 ウルトラガイド・リミテッド 分娩の経過をモニタする方法及び装置
JP2009090107A (ja) * 2007-10-04 2009-04-30 General Electric Co <Ge> 超音波による分娩の診察のための方法及び装置
CN110432929A (zh) * 2019-07-11 2019-11-12 暨南大学 基于超声图像的产时头盆关系自动测量方法和装置
WO2020159008A1 (fr) * 2019-01-30 2020-08-06 삼성메디슨 주식회사 Dispositif d'imagerie ultrasonore et procédé de génération d'image ultrasonore

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JP2001504380A (ja) * 1997-05-05 2001-04-03 ウルトラガイド・リミテッド 分娩の経過をモニタする方法及び装置
JP2009090107A (ja) * 2007-10-04 2009-04-30 General Electric Co <Ge> 超音波による分娩の診察のための方法及び装置
WO2020159008A1 (fr) * 2019-01-30 2020-08-06 삼성메디슨 주식회사 Dispositif d'imagerie ultrasonore et procédé de génération d'image ultrasonore
CN110432929A (zh) * 2019-07-11 2019-11-12 暨南大学 基于超声图像的产时头盆关系自动测量方法和装置

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