Hofmeyr G J, Hannah M E
(Director, Effective Care Research Unit, University of the Witwatersrand), Frere/Cecilia Makiwane Hospitals, Private Bag 9047, East London 5200, Eastern Cape, SOUTH AFRICA.
Cochrane Database Syst Rev. 2001(1):CD000166. doi: 10.1002/14651858.CD000166.
Routine use of caesarean section for breech presentation is widespread. However, poor outcomes after breech birth might be the result of underlying conditions causing breech presentation rather than damage during delivery.
The objective of this review was to assess the effects of planned caesarean section for breech presentation on measures of pregnancy outcome.
We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials register. Date of last search: November 2000.
Randomised trials comparing planned caesarean section for breech presentation with planned vaginal delivery.
Reviewers assessed trial eligibility and quality. Data were entered onto and analysed using RevMan software.
Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Planned caesarean section was associated with modestly increased maternal morbidity (relative risk 1.29, 95% confidence interval 1.03 to 1.61). Perinatal and neonatal death (excluding fatal anomalies) were greatly reduced (0.29, 0.10 to 0.86). The reductions were similar for countries with low and high perinatal mortality rates. Perinatal/neonatal death or neonatal morbidity was also greatly reduced (0.31, 0.19 to 0.52). The difference was smaller for countries with a high national perinatal mortality rate.
REVIEWER'S CONCLUSIONS: Planned caesarean section greatly reduces both perinatal/neonatal mortality and neonatal morbidity, at the expense of somewhat increased maternal morbidity. Cost, and future morbidity due to the caesarean section scar were not assessed. The option of external cephalic version is dealt with in separate reviews. The data from this review will help to inform individualised decision-making regarding breech delivery.
臀位分娩常规采用剖宫产术的情况很普遍。然而，臀位出生后不良结局可能是导致臀位的潜在状况所致，而非分娩过程中的损伤。
本综述的目的是评估计划剖宫产术对臀位分娩妊娠结局指标的影响。
我们检索了Cochrane妊娠与分娩试验注册库和Cochrane对照试验注册库。最后检索日期：2000年11月。
比较计划剖宫产术与计划阴道分娩治疗臀位的随机试验。
综述作者评估试验的合格性和质量。数据录入RevMan软件并进行分析。
分配至阴道分娩方案的女性中有550/1227（45%）接受了剖宫产。计划剖宫产与产妇发病率适度增加相关（相对危险度1.29，95%可信区间1.03至1.61）。围产期和新生儿死亡（不包括致命畸形）大幅降低（0.29，0.10至0.86）。围产期死亡率低和高的国家降低幅度相似。围产期/新生儿死亡或新生儿发病率也大幅降低（0.31，0.19至0.52）。国家围产期死亡率高的国家差异较小。
计划剖宫产术可大幅降低围产期/新生儿死亡率和新生儿发病率，但以产妇发病率略有增加为代价。未评估剖宫产瘢痕的成本和未来发病率。外倒转术的选择在单独的综述中讨论。本综述的数据将有助于为臀位分娩的个体化决策提供参考。
