外倒转术成功的影响因素:118例分析

Factors influencing success of external cephalic version:analysis of 118 cases

目的探讨影响外倒转术成功的因素。方法回顾性选择2015年7月至2021年7月于郑州大学第三附属医院因臀位或横位行外倒转术,且由同一术者操作的产妇作为研究对象(n=118)。应用单因素及logistic回归分析探讨外倒转术成功的临床影响因素;应用受试者工作特征(receiver operating characteristic,ROC)曲线分析手术孕周及羊水指数的最佳界值,评价这些影响因素预测外倒转术成功的价值。结果(1)118例中,外倒转术成功77例(65.3%),其中初产妇成功率为49.1%(27/55),经产妇成功率为79.4%(50/63);56.8%(67/118)经阴道分娩。(2)118例中的19例(16.1%)发生并发症,主要并发症为胎心异常(13例,11.0%)、脐带先露和胎位复转(各2例,分别占1.7%),严重并发症为胎儿宫内死亡和胎盘早剥(各1例,分别占0.8%)。外倒转成功者并发症发生率为7.8%(6/77),低于外倒转失败者的31.7%(13/41)(χ^(2)=11.33,P=0.001)。(3)多因素分析显示,手术孕周<38周、羊水指数>11.10 cm和经产妇是影响外倒转术成功的因素[OR值(95%CI)分别为0.561(0.351~0.897)、1.173(1.018~1.351)和4.201(1.547~11.404),P值均<0.05]。(4)手术孕周、羊水指数及产次三者联合的ROC曲线下面积为0.744(95%CI:0.640~0.848,P<0.001),其约登指数为0.518,灵敏度为70.0%,特异度为81.8%。结论手术孕周、羊水指数及经产妇与外倒转术成功相关。三者联合对手术成功有一定的预测价值。

Objective To investigate the factors influencing the success of external cephalic version.Methods Pregnant women who underwent an external cephalic version due to breech or transverse presentation by the same operator in the Third Affiliated Hospital of Zhengzhou University from July 2015 to July 2021 were selected as the study objects.Univariate analysis and logistic regression analysis were used to explore the clinical factors influencing the success of the external cephalic version.The receiver operating characteristic(ROC)curve was used to analyze the best cut-off value of gestational week and amniotic fluid index at the time of operation and to evaluate the predictive value of the influencing factors on the success of the external cephalic version.Results(1)A total of 118 cases finally entered this study.Among the 118 cases,77 cases(65.3%)succeeded in the external cephalic version,among which the success rate was 49.1%(27/55)for primipara and 79.4%(50/63)for multipara.The vaginal delivery rate was 56.8%(67/118).(2)Complications occurred in 19(16.1%)of the 118 cases.The main complications were abnormal fetal heart rate(13 cases,11.0%),umbilical cord presentation,and fetal position reversion(two cases and 1.7%in each),and the serious complications were intrauterine fetal death and placental abruption(one case and 0.8%in each).The complication rate of patients with successful external cephalic version was 7.8%(6/77),which was lower than that of those who failed the external cephalic version[31.7%(13/41)](χ^(2)=11.33,P=0.001).(3)Multivariate analysis showed that gestational week at surgery before 38,amniotic fluid index>11.10 cm,and multipara were the factors affecting the success of the external cephalic version[OR(95%CI)=0.561(0.351-0.897),1.173(1.018-1.351)and 4.201(1.547-11.404),all P<0.05].(4)The area under the ROC curve of the combination of the gestational week at surgery,amniotic fluid index,and parity was 0.744(95%CI:0.640-0.848,P<0.001),and the Youden index was 0.518,with a sensitivity of 70.0%and a specificity of 81.8%.Conclusion Gestational weeks,amniotic fluid index,and multipara are related to the success of the external cephalic version,and the combination of the three has certain predictive power for the success of the surgery.