Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification o...Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.展开更多
目的:探讨足月臀位外倒转术成功的相关因素。方法:以2014年4月至2017年4月在首都医科大学附属北京妇产医院定期产检的≥孕37周单胎臀位行外倒转术(均行椎管内麻醉)的孕妇149例为研究对象,按照倒转成功与否分为成功组和失败组,将相关因素...目的:探讨足月臀位外倒转术成功的相关因素。方法:以2014年4月至2017年4月在首都医科大学附属北京妇产医院定期产检的≥孕37周单胎臀位行外倒转术(均行椎管内麻醉)的孕妇149例为研究对象,按照倒转成功与否分为成功组和失败组,将相关因素(产妇年龄、产次、孕周、体质量指数、脐带长度、羊水指数、新生儿体质量、臀先露类型、绕颈与否、胎盘位置、是否使用宫缩抑制剂)行单因素分析和Logistic回归多因素分析。结果:149例行足月臀位外倒转术的孕妇中,成功59例,成功率39.60%。单因素分析结果提示:成功组(59例)与失败组(90例)脐带长度(54.00±5.92 cm vs 49.89±9.95 cm)和产次(初产妇与经产妇)差异有统计学意义(P<0.05)。多因素分析结果提示:产次、宫缩抑制剂、脐带长度是足月臀位外倒转手术成功的影响因素(P<0.05)。结论:多学科联合下进行足月臀位外倒转术是安全可行的,其成功的相关因素可能与产次、使用宫缩抑制剂和脐带长度有关。选择合适的病例,术前使用宫缩抑制剂,建议行椎管内麻醉,术中及术后加强观察和母儿监护,以达到安全分娩的目的。展开更多
文摘Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
文摘目的:探讨足月臀位外倒转术成功的相关因素。方法:以2014年4月至2017年4月在首都医科大学附属北京妇产医院定期产检的≥孕37周单胎臀位行外倒转术(均行椎管内麻醉)的孕妇149例为研究对象,按照倒转成功与否分为成功组和失败组,将相关因素(产妇年龄、产次、孕周、体质量指数、脐带长度、羊水指数、新生儿体质量、臀先露类型、绕颈与否、胎盘位置、是否使用宫缩抑制剂)行单因素分析和Logistic回归多因素分析。结果:149例行足月臀位外倒转术的孕妇中,成功59例,成功率39.60%。单因素分析结果提示:成功组(59例)与失败组(90例)脐带长度(54.00±5.92 cm vs 49.89±9.95 cm)和产次(初产妇与经产妇)差异有统计学意义(P<0.05)。多因素分析结果提示:产次、宫缩抑制剂、脐带长度是足月臀位外倒转手术成功的影响因素(P<0.05)。结论:多学科联合下进行足月臀位外倒转术是安全可行的,其成功的相关因素可能与产次、使用宫缩抑制剂和脐带长度有关。选择合适的病例,术前使用宫缩抑制剂,建议行椎管内麻醉,术中及术后加强观察和母儿监护,以达到安全分娩的目的。
