产次对足月臀位外倒转术的影响

Effect of parity on the external cephalic version for breech presentation at term

目的探讨产次对于足月臀位外倒转术效果和分娩结局的影响。方法回顾性分析2015年1月至2021年2月在首都医科大学附属北京妇产医院产检的晚孕期单胎臀位孕妇,选取其中自愿选择行臀位外倒转术的孕37~40周的孕妇368例,分为初产组和经产组。记录并比较两组臀位外倒转成功率、剖宫产率、阴道分娩率、复转率、产后出血率、新生儿窒息率的差异。结果(1)368例孕妇行臀位外倒转术,成功152例,总体外倒转成功率41.30%,经产组的倒转成功率56.43%(79/140)高于初产组的成功率32.02%(73/228),差异有统计学意义(P<0.01);总体阴道分娩率为33.97%(125/368),其中经产组阴道分娩率50.00%(70/140)高于初产组24.12%(55/228),差异有统计学意义(P<0.01)。而成功外倒转后的孕妇总阴道分娩率82.24%(125/152),经产妇88.61%(70/79),初产妇75.34%(55/73)。(2)两组复转率、产后出血率、新生儿窒息率比较,差异无统计学意义(P>0.05)。结论经产妇更适合行臀位外倒转术,手术成功率和阴道分娩率增加,这对于选择臀位外倒转术的适宜人群有指导意义。

Objective To investigate the effect of parity on the external cephalic version(ECV)for breech presentation at term and its impact of parity on the perinatal outcome.Methods A total of 368 cases of singleton pregnant women with breech pregnancy at 37~40 weeks from January 2015 to February 2021 in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University were retrospectively analyzed.All subjects were divided into the multipara group and the primipara group according to the parity.The success rate of ECV,cesarean section rate,vaginal delivery rate,retroversion rate,postpartum hemorrhage rate,neonatal asphyxia rate were compared between the two groups.Results A total of 368 pregnant women received ECV and the total success rate was 41.30%(n=152).The success rate in the multipara group was 56.43%(79/140)vs 32.02%(73/228)in the primipara group(P<0.01).The total vaginal delivery rate was 33.97%(125/368),which was higher among the multipara group(50.00%,70/140)as compared with the primipara group(24.12%,55/228)(P<0.01).After successful ECV,the vaginal delivery rate was 82.24%(125/152),which was 88.61%(70/79)in the multipara group vs.75.34%(55/73)in the primipara group.There were no significant difference(P>0.05)among the reversion rate after successful ECV,postpartum hemorrhage rate and neonatal asphyxia rate between the two groups.Conclusions The multiparas are more suitable for ECV,and the success rate of the operation and the vaginal delivery rate increase significantly,which is instructive to select suitable candidates for ECV.