Alarab May, Regan Carmen, O'Connell Michael P, Keane Declan P, O'Herlihy Colm, Foley Michael E
Departments of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
Obstet Gynecol. 2004 Mar;103(3):407-12. doi: 10.1097/01.AOG.0000113625.29073.4c.
To examine the obstetric and perinatal outcome of pregnancies with singleton breech presentation at term when selection for vaginal delivery was based on clear prelabor and intrapartum criteria.
The outcomes of all pregnancies with a breech presentation after 37 weeks of gestation were retrospectively reviewed from January 1997 to June 2000. Criteria for prelabor cesarean or trial of vaginal breech delivery included type of breech, estimated fetal weight (more than 3,800 g), maternal preference, and gestation more than 41 weeks. An intrapartum protocol excluded induction and oxytocin augmentation of labor, combined with a low threshold for cesarean delivery for dystocic labor; an experienced obstetrician was in attendance during labor and delivery.
Of 641 women, 343 (54%) underwent prelabor cesarean, and 298 (46%) had a trial of vaginal delivery, of whom 146 (49%) delivered vaginally. Significantly fewer nulliparas (58 of 158, 37%) than multiparas (88 of 140, 63%; P <.001) achieved vaginal delivery after trial of labor. Significantly more infants weighing more than 3,800 g were selected for prelabor (87 of 343, 25%) and intrapartum (31 of 152, 20%) cesarean than delivered vaginally (15 of 146, 10%). Two neonates (0.7%) had Apgar scores of less than 7 at 5 minutes; both were neurologically normal at 6 weeks. There were no nonanomalous perinatal deaths and no cases of significant trauma or neurological dysfunction; 3 infants delivered vaginally died due to lethal anomalies.
Safe vaginal breech delivery at term can be achieved with strict selection criteria, adherence to a careful intrapartum protocol, and with an experienced obstetrician in attendance. Our protocol effectively selects larger infants for cesarean delivery.
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探讨足月单臀先露妊娠在根据明确的分娩前和分娩期标准选择阴道分娩时的产科及围产期结局。
回顾性分析1997年1月至2000年6月所有妊娠37周后臀先露妊娠的结局。分娩前剖宫产或臀位阴道试产的标准包括臀先露类型、估计胎儿体重（超过3800g）、产妇意愿以及孕周超过41周。分娩期方案排除引产和缩宫素加强宫缩，并对难产分娩设定较低的剖宫产阈值；分娩和接生期间有经验丰富的产科医生在场。
641名妇女中，343名（54%）在分娩前接受了剖宫产，298名（46%）进行了阴道试产，其中146名（49%）经阴道分娩。经试产，初产妇（158名中的58名，37%）阴道分娩的比例显著低于经产妇（140名中的88名，63%；P<.001）。体重超过3800g的婴儿中，选择分娩前剖宫产（343名中的87名，25%）和分娩期剖宫产（152名中的31名，20%）的比例显著高于经阴道分娩（146名中的15名，10%）。两名新生儿（0.7%）5分钟时Apgar评分低于7分；6周时神经功能均正常。无围产期非畸形死亡病例，无严重创伤或神经功能障碍病例；3名经阴道分娩的婴儿因致命畸形死亡。
通过严格的选择标准、严格遵守仔细的分娩期方案以及有经验丰富的产科医生在场，可实现足月单臀先露的安全阴道分娩。我们的方案有效地选择较大的婴儿进行剖宫产。
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