Golfier F, Vaudoyer F, Ecochard R, Champion F, Audra P, Raudrant D
Department of Obstetrics, Claude Bernard University, Hôtel Dieu Hospital, School of Medicine, Lyon, France.
Eur J Obstet Gynecol Reprod Biol. 2001 Oct;98(2):186-92. doi: 10.1016/s0301-2115(01)00333-5.
To compare neonatal and maternal morbidity and mortality between planned vaginal delivery and elective cesarean section for singleton term breech presentation.
We studied retrospectively all deliveries of singleton breech presentations at term in the public Hospitals of Lyon between 1 January 1991 and 31 December 1995. To take only the effect of delivery on the fetus into account, we eliminated high risk pregnancies and fetal malformations. Fetal parameters were corrected perinatal mortality, Apgar score<7 at 1 and 5 min, umbilical cord arterial pH<7.15, neurological disorders, trauma and need for neonatal intensive care. Maternal parameters were mild, moderate and severe complications.
Of the 1116 breech presentations, 702 (62.9%) underwent an elective caesarean section and 414 (37.1%) a planned vaginal delivery. In the latter group, 342 (30.6%) had a vaginal delivery and 72 (6.5%) a non-elective caesarean section. Infants for whom the vaginal route was planned were at higher risk of mortality and morbidity. There were 2 deaths in this group and none in the elective caesarean section group and all fetal parameters were poorer: more Apgar<7 at 5 min (RR: relative risk=3.05; 1.03-9.05), arterial pH<7.15 (RR=1.64; 1.11-2.43), intubations (RR=7.35; 2.10-25.6), neurological disorders, trauma (RR=4.24; 1.66-10.8), transfer to intensive care units (RR=3.23; 1.57-6.64). The overall maternal morbidity was lower in the planned vaginal delivery group (RR=0.65; 0.44-0.94) but this was only because of less mild complications. The moderate and severe complications were the same in the two groups (RR=0.97; 0.59-1.57).
Planned vaginal delivery in singleton term breech presentation increases the risk of death and of neonatal complications. Elective caesarean section increases the risk of only mild maternal complications. For these reasons, elective caesarean section should be preferred for singleton term breech presentations.
比较单胎足月臀位计划性阴道分娩与选择性剖宫产的新生儿及产妇发病率和死亡率。
我们回顾性研究了1991年1月1日至1995年12月31日期间里昂公立医院所有单胎足月臀位分娩情况。为仅考虑分娩对胎儿的影响，我们排除了高危妊娠和胎儿畸形。胎儿参数为校正围产儿死亡率、1分钟和5分钟时阿氏评分<7分、脐动脉pH<7.15、神经系统疾病、创伤以及新生儿重症监护需求。产妇参数为轻度、中度和重度并发症。
在1116例臀位分娩中，702例（62.9%）接受了选择性剖宫产，414例（37.1%）为计划性阴道分娩。在后一组中，342例（30.6%）经阴道分娩，72例（6.5%）接受了非选择性剖宫产。计划经阴道分娩的婴儿死亡和发病风险更高。该组有2例死亡，选择性剖宫产组无死亡，且所有胎儿参数均较差：5分钟时更多阿氏评分<7分（RR：相对风险=3.05；1.03 - 9.05）、动脉pH<7.（RR=1.64；1.11 - 2.43）、插管（RR=7.35；2.10 - 25.6）、神经系统疾病、创伤（RR=4.24；1.66 - 10.8）、转入重症监护病房（RR=3.23；1.57 - 6.64）。计划性阴道分娩组的总体产妇发病率较低（RR=0.65；0.44 - 0.94），但这仅因轻度并发症较少。两组的中度和重度并发症相同（RR=0.97；0.59 - 1.57）。
单胎足月臀位计划性阴道分娩会增加死亡和新生儿并发症风险。选择性剖宫产仅增加轻度产妇并发症风险。基于这些原因，单胎足月臀位应首选选择性剖宫产。
