孕晚期臀位外倒转术的安全性和影响因素的临床分析

Clinical Characteristics and Outcomes of 80 Pregnant Women after External Cephalic Version

【目的】探讨孕晚期臀位外倒转术的安全性和影响外倒转术成功的相关因素。【方法】收集2015年9月至2017年7月在中山大学附属第三医院孕晚期实施外倒转术的80例孕妇患者作为研究对象,按照外倒转成功与否分为成功组和失败组,对两组的相关因素(年龄、产次、BMI、羊水量、胎盘位置、脐带绕颈和胎儿估重等)及妊娠结局进行单因素统计学分析。【结果】80例患者中,外倒转手术成功48例(60.0%),失败32例(40.0%);成功组与失败组间,患者产次,BMI,羊水深度的差异具有有统计学意义(P<0.05);成功组中有3例(6.2%)行剖宫产术,失败组中均择期剖宫产(100.0%)。实施外倒转术的80例患者,无外倒转术中急诊剖宫产,无新生儿窒息,胎膜早破发生11例(13.8%)。外倒转失败原因包括患者腹部肌肉紧张合并疼痛不能耐受12例(37.5%),腹部肌肉紧张合并疼痛可耐受9例(28.0%),操作过程中出现宫缩2例(6.3%),先露已入盆难以上推出骨盆5例(15.6%),复位至臀位2例(6.3%),操作过程中胎心短期减慢2例(6.3%)。【结论】患者产次、BMI和羊水深度是外倒转成功率的影响因素;外倒转术操作安全性高,选择合适的病例,改善腹肌紧张、疼痛、宫缩等因素,可增加外倒转成功率。

【Objective】To investigate the safety and associated factor of external cephalic version（ECV）in third trimester,and to enrich clinical experience to improve the successful rate and lower cesarean section（CS） rate.【Methods】80 pregnant women conducting ECV in third trimester in the third affiliated hospital of Sun Yat-sen University from September 2015 to July 2017 were enrolled in our study. Divided to successful group and failing group,we compared the clinical characters and pregnancy outcomes. 【Results】 Of the 80 pregnancy,48 women（60.0%） succeed with cephalic presentation. Compared to the failing group,the successful group is statistically different in parity,BMI and amniotic fluid depth. In the failing group,all women underwent CS with 3/48 in successful group. No women conducted ECV complicated fetal distress and emergency CS,premature rupture of membranes complicated in 11（13.8%）cases in all women.【Conclusions】ECV is safe for mother and fetus. Encouraging the suitable pregnancy women to conduct ECV and enhancing clinical skills can improve ECV success rate.