Impey L, Lissoni D
The Women's Center, The Oxford Radcliffe Hospital, Headington, UK.
J Matern Fetal Med. 1999 Sep-Oct;8(5):203-7. doi: 10.1002/(SICI)1520-6661(199909/10)8:5<203::AID-MFM1>3.0.CO;2-Y.
Despite its efficacy, external cephalic version (ECV) at term is not universally employed. Published series of Caucasian women are small and concerns regarding safety and spontaneous version remain. We review the outcomes of 26 months of a breech clinic in a Dublin teaching hospital.
All women with known breech presentation at 36+ weeks were referred unless another indication for cesarean section existed. Unstable lie, fetal compromise, antepartum hemorrhage, and patient refusal were the only contraindications to ECV. One operator attempted all versions, without tocolysis.
Three hundred seventy women were referred and in 356 (95%), version was attempted at a mean gestation of 37 + 3 weeks; 195 (55%) were nulliparous and 161 (45%) were multiparous. The success rate was 43%, including 33% of nulliparous and 54% of multiparous women. There were three perinatal deaths (0.8%), all unrelated to the version. Minor complications were rare, although two women were delivered by cesarean section shortly after unsuccessful version. Ninety-three percent of successful versions were cephalic at delivery, as were 4% of unsuccessful versions; 12% of infants with a cephalic presentation after successful version were delivered by cesarean section.
From this large series, ECV is extremely safe. Spontaneous version after unsuccessful ECV and reversion after successful ECV are unusual.
尽管足月外倒转术（ECV）有效，但并未被广泛应用。已发表的关于白人女性的系列研究规模较小，且对其安全性和自然倒转仍存在担忧。我们回顾了都柏林一家教学医院26个月臀位门诊的结果。
所有孕36 + 周已知为臀位的孕妇，除非存在剖宫产的其他指征，均被转诊。胎位不稳、胎儿窘迫、产前出血和患者拒绝是ECV的唯一禁忌证。由一名操作人员尝试所有的倒转术，不使用宫缩抑制剂。
370名孕妇被转诊，其中356名（95%）在平均孕周37 + 3周时尝试倒转术；195名（55%）为初产妇，161名（45%）为经产妇。成功率为43%，其中初产妇为33%，经产妇为54%。围产期死亡3例（0.8%），均与倒转术无关。轻微并发症很少见，尽管有两名女性在倒转术失败后不久行剖宫产分娩。93%的成功倒转术在分娩时转为头位，失败倒转术中4%转为头位；成功倒转术后转为头位的婴儿中有12%通过剖宫产分娩。
从这个大样本系列研究来看，ECV极其安全。ECV失败后的自然倒转和成功后的复转都不常见。
