75例臀位外倒转术临床分析

Clinical Analysis of 75 Cases of External Cephalic Version for Breech Presentation

目的探讨足月单胎臀位外倒转术的影响因素、成功率及并发症情况。方法以2014年4月～2016年4月在笔者医院定期产检的≥37孕周单胎臀位行外倒转术的孕妇75例为研究对象，对其妊娠结局进行分析。按照倒转成功与否分为成功组和失败组，将相关因素（产妇年龄、孕周、BMI、脐带长度、羊水指数、新生儿体重、产次、臀先露类型、绕颈与否、胎盘位置、是否使用宫缩抑制剂）进行统计学分析，从而探讨其成功的影响因素。统计学分析采用单因素分析。结果75例单胎臀位行外倒转术的孕妇中，倒转成功32例（42．67％，无病例复变），失败43例（57．33％）。倒转成功的32例中，有6例剖宫产（18．75％）。并发症有胎膜早破1例，胎心轻度可变减速16例，胎儿窘迫5例，无新生儿窒息。成功相关因素统计分析结果，两组脐带长度差异有统计学意义（P〈0．05），其余因素差异均无统计学意义（P〉0．05）。结论臀位外倒转术大大降低了剖宫产率，影响外倒转术成功的其他相关因素需大样本量的进一步研究。对于单胎臀位的孕妇，在决定行外倒转术之前，应充分评估相关因素，严格筛选患者，掌握其适应证和禁忌证，提高外倒转的成功率。

Objective To discuss the success rate of external cephalic version（ECV） for breechpresentation in maturesingleton preg- nancies and the factors influencing ECV, and complications induced by ECV. Methods A study was conducted which included 75 preg- nant women who underwent regular prenatal examinations and delivered in Beijing Obstetrics and Gynecology Hospital between April 2014 and April 2016. They were all singleton breech presentation and performed ECV. Their pregnancy outcomes were analyzed. They were di- vided into success group and failure group. The related factors （ the age, gestational age, BMI, the length of the umbilical cord, amniotic fluid index, birth weight, parturition number, type of breech presentation, cord around neck or not, placental location, whether to colyt- ies） were statistically analyzed and to explore the sueeessfaetors. Statistical analysis was performed using univariate analysis. Results In the 75 cases of ECV pregnant women, 32 cases were successful （42.67% , no ease of restored） , 43 cases were failed （57.33%）. In the successful 32 cases, six cases were cesarean deliveries （ 18.75% ）. Complications included one case of PROM, 16 cases of mild fetal heart rate variable deceleration, 5 cases of fetal distress, no neonatal asphyxia. According to the statistical analysis results, significant differences were observed in the length of the umbilical cord between the success group and failure group（ P 〈 0.05 ） , and the other factors were not found significantly differences （P 〉 0.05 ）. Conclusion The ECV significantly reduces the rate of cesarean section. Further study of a large sample sizes is needed for the other success factors influencing ECV. Before the ECV, we must make a full assessment of the pregnant woman, master the indications and contraindications, thereby to improve the success rate of external cephalic version.