臀位外倒转术对单胎足月臀位孕妇分娩方式及母婴结局的影响

Effects of external cephalic version on the delivery mode of single term breech fetus and on the maternal and infant outcomes

目的探讨臀位外倒转术对单胎足月臀位孕妇分娩方式及母婴结局的影响。方法选择132例单胎足月臀位孕妇作为观察组,均实施臀位外倒转术;选择同期分娩的130例足月单胎臀位孕妇作为对照组,未实施臀位外倒转术。观察臀位外倒转术的成功率、臀位外倒转孕妇追踪情况;比较两组分娩方式、不良结局发生情况;观察两组孕妇住院费用。结果观察组中外倒转成功94例,失败38例,成功率为71.21%。外倒转成功孕妇中顺利阴道分娩81例,外倒转术后当天因胎盘早剥行剖宫产术1例,因术后出现胎心减慢经宫内复苏无好转考虑胎儿窘迫行剖宫产1例,阴道试产后中转剖宫产术11例,外倒转成功孕妇阴道分娩率为86.17%(81/94)。外倒转失败孕妇2例因临产行臀助产阴道分娩,36例行择期剖宫产术。观察组阴道分娩率62.88%高于对照组的3.08%,差异具有统计学意义(P<0.05)。两组不良结局发生率比较差异无统计学意义(P>0.05)。结论多学科联合下对单胎足月臀位孕妇实施臀位外倒转术,术前使用宫缩抑制剂,术中床边B超监测和指引,术后加强胎心电子监护,能成功将臀位转为头位,有效降低剖宫产率,是一种可行、有效和安全的方法。

Objective To investigate the effects of external cephalic version on delivery mode of single term breech fetus and on the maternal and infant outcomes.Methods 132 pregnant women with single term breech fetus were selected as an observation group,all of them were treated with external cephalic version;and 130 pregnant women with single term breech fetus delivered at the same time were selected as a control group,all of them were not treated with external cephalic version.The success rate of external cephalic version was observed,and the pregnant women treated with external cephalic version were followed up.Delivery mode and incidence of complications were compared between these two groups.The hospitalization expenses of these two groups were observed.Results In the observation group,94 external cephalic version cases succeed,while 38 cases failed,leading to a success rate of 71.21%.In the pregnant women with successful external cephalic version,81 cases were successful vaginal delivery;1 case was performed with cesarean section due to placental abruption on the day of external cephalic version;1 case was performed with cesarean section on consideration of fetal distress,because the fetal heart rate slowed down after operation and no improvement after intrauterine resuscitation;and 11 cases were converted to cesarean section after trial of vaginal delivery;as a result,the rate of vaginal delivery for pregnant women with successful external cephalic version was 86.17%(81/94).For pregnant women with failed external cephalic version,2 cases were performed with assisted breech delivery due to parturient;36 cases were performed with elective cesarean section.The rate of vaginal delivery in the observation group was 62.88%,which was higher than 3.08%in the control group,and the difference was statistically significant(P<0.05).The difference in the incidence of adverse outcomes between these two groups was not statistically significant(P>0.05).Conclusion It is a feasible,effective and safe method to perform external cephalic version for pregnant women with single term breech fetus under multidisciplinary cooperation.Specifically,uterine contraction inhibitor is utilized before operation,with bedside B-ultrasound monitoring and guidance during opertation,and electronic monitoring of fetal heart rate is enhanced after operation,so that the breech position can be successfully converted to head position,resulting in an effective decrease in cesarean section rate.