臀位外倒转术对妊娠晚期臀位妊娠产妇分娩方式及母婴结局的影响

Effect of external breech conversion on delivery mode and maternal and infant outcomes in breech presentation during late pregnancy

目的 探讨臀位外倒转术对妊娠晚期臀位妊娠产妇分娩方式及母婴结局的影响。方法 选取2019年1月至2021年12月在许昌市妇幼保健院分娩的,经过B超确认为臀位妊娠的62例产妇为研究对象,将其随机分为对照组与观察组,每组31例。对照组采用膝胸卧位进行臀位矫正,观察组采用臀位外倒转术。比较两组分娩方式、臀位矫正成功率及母婴结局。结果 观察组的阴道分娩率明显高于对照组(58.06%比29.03%,P=0.021),而对照组的剖宫产率明显高于观察组(70.97%比41.94%,P=0.021)。观察组臀位矫正成功率为77.42%(24/31),显著高于对照组[51.61%(16/31)],差异有统计学意义(P=0.034)。观察组出现3例脐带绕颈,1例胎膜早破,1例胎儿窘迫;对照组出现5例脐带绕颈,5例胎膜早破,1例胎盘早剥,2例胎儿窘迫,1例新生儿窒息。观察组不良母婴结局总发生率为16.13%(5/31),显著低于对照组[45.16%(14/31)],差异有统计学意义(P=0.013)。结论 对妊娠晚期臀位妊娠产妇采用臀位外倒转术可以显著提高阴道分娩率,降低不良母婴结局的发生率。

Objective To investigate the effect of breech external cephalic version on delivery mode and maternal and infant outcomes in breech presentation during late pregnancy. Methods Sixty-two cases of breech presentation confirmed by B-ultrasound in Xuchang Maternity and Child Care Hospital from January 2019 to December 2021 were randomly divided into observation group and control group, with 31 cases in each group. The control group was treated with knee-chest position for breech correction, and the observation group was treated with breech external version. The delivery mode, success rate of breech correction and maternal and infant outcomes were compared between the two groups. Results The vaginal delivery rate in the observation group was significantly higher than that in the control group(58.06%vs. 29.03%, P=0.021), while the cesarean section rate in the control group was significantly higher than that in the observation group(70.97%vs. 41.94%, P=0.021). The success rate of breech correction in the observation group was 77.42%(24/31), which was significantly higher than that(51.61%, 16/31) in the control group, and the difference was significant(P=0.034). In the observation group, there were 3 cases of umbilical cord around the neck, 1 case of premature rupture of membranes, and 1 case of fetal distress. In the control group, there were 5 cases of umbilical cord around the neck, 5 cases of premature rupture of membranes, 1 case of placental abruption, 2 cases of fetal distress, and 1 case of neonatal asphyxia. The total incidence of adverse maternal and infant outcomes in the observation group was 16.13%(5/31), which was significantly lower than that(45.16%, 14/31) in the control group, and the difference was significant(P=0.013). Conclusions In breech presentation during late pregnancy, breech external version can significantly improve the vaginal delivery rate and reduce the incidence of adverse maternal and infant outcomes.