Vézina Yannik, Bujold Emmanuel, Varin Jocelyne, Marquette Gérald P, Boucher Marc
Department of Obstetrics and Gynecology, Hôpital Sainte-Justine, Montréal, Québec, Canada.
Am J Obstet Gynecol. 2004 Mar;190(3):763-8. doi: 10.1016/j.ajog.2003.09.056.
The purpose of this study was to evaluate the rate and indications of cesarean delivery after a successful external cephalic version.
A case-control study was performed from patients who were delivered in a tertiary care center between 1987 and 2000. Each patient who underwent a successful external cephalic version (study group) was compared with the next woman with the same parity, who was delivered at term (control group). Nulliparous and multiparous women were analyzed separately. Chi-squared, Mann-Whitney, and Student t tests were used for statistical analysis. Multivariate logistic regression analysis was performed where appropriate.
A total of 602 patients were included in this study. The rates of cesarean delivery in nulliparous women (29.8% vs 15.9%; P<.001) and in multiparous women (15.9% vs 4.7%; P<.001) were significantly higher when compared with the control group. Patients with successful external cephalic version were more likely to have a cesarean delivery for dystocia (nulliparous, 22.5% vs 11.9%; P=.01; multiparous, 10.9% vs 1.3%; P<.01). After an adjustment for confounding variables, a successful external cephalic version was associated with an increased rate of cesarean delivery at term (nulliparous: odds ratio, 2.04; 95% CI, 1.13-3.68; multiparous: odds ratio, 4.30; 95% CI, 1.76-10.54).
The rate of cesarean delivery for dystocia is increased after a successful trial of external cephalic version in both nulliparous and multiparous women.
本研究旨在评估外倒转术成功后剖宫产的发生率及指征。
对1987年至2000年在一家三级医疗中心分娩的患者进行病例对照研究。将每例接受外倒转术成功的患者（研究组）与下一位同孕周分娩的同胎次女性（对照组）进行比较。初产妇和经产妇分别进行分析。采用卡方检验、曼-惠特尼检验和学生t检验进行统计学分析。在适当情况下进行多因素逻辑回归分析。
本研究共纳入602例患者。与对照组相比，初产妇（29.8%对15.9%；P<0.001）和经产妇（15.9%对4.7%；P<0.001）的剖宫产率显著更高。外倒转术成功的患者因难产行剖宫产的可能性更大（初产妇，22.5%对11.9%；P=0.01；经产妇，10.9%对1.3%；P<0.01）。在对混杂变量进行调整后，外倒转术成功与足月剖宫产率增加相关（初产妇：比值比，2.04；95%可信区间，1.13 - 3.68；经产妇：比值比，4.30；95%可信区间，1.76 - 10.54）。
初产妇和经产妇外倒转术成功试验后，因难产行剖宫产的发生率增加。
