Vasilj Oliver, Matijević Ratko, Grgić Ozren
Klinika za ginekologiju i porodnistvo, Opća bolnica Sveti Duh, Zagreb, Hrvatska.
Acta Med Croatica. 2007 Apr;61(2):177-84.
The management of preterm and term delivery of fetus in breech presentation is one of the most disputable issues in modern obstetric practice. Several years ago, one of the biggest randomized controlled studies in obstetrics, Term Breech Trial (TBT), tried to set up guidelines and resolve the question of the best method to deliver the fetus at term in breech presentation. The results of this study have shown that the policy of planned cesarean section reduces the risk of short-term adverse perinatal outcome, compared with the policy of planned vaginal birth. Many perinatal centers have accepted the recommendations from this study and different obstetric associations have implemented these results in their guidelines. On the other hand, TBT had some limitations, especially those connected with the impossibility of regular and objective comparison of these two methods of delivery. In addition, the same group of authors did not find differences in long-term outcomes between the planned cesarean section and vaginal delivery. Although the rate of planned cesarean section has increased following the publication of TBT, selective vaginal breech delivery is still very successfully used in the centers where doctors have the possibility to obtain experience in vaginal breech deliveries. The most common method of reduce the noncephalic presentation is external cephalic version at term. It reduces the incidence of noncephalic presentations at labor, thus reducing the number of cesarean sections as well. At this moment, there is not enough evidence to support cesarean section as the method of choice for delivery of preterm and term breech, having in mind obstetric indications and criteria. The decision whether to deliver vaginally or by cesarean section should be individual for each pregnant woman.
臀位胎儿早产和足月产的管理是现代产科实践中最具争议的问题之一。几年前，产科领域最大的随机对照研究之一——足月臀位试验（TBT），试图制定指南并解决足月臀位胎儿最佳分娩方式的问题。这项研究的结果表明，与计划阴道分娩策略相比，计划剖宫产策略可降低短期围产期不良结局的风险。许多围产期中心接受了该研究的建议，不同的产科协会也已将这些结果纳入其指南。另一方面，TBT存在一些局限性，尤其是无法对这两种分娩方式进行常规且客观的比较。此外，同一组作者并未发现计划剖宫产与阴道分娩在长期结局上存在差异。尽管TBT发表后计划剖宫产率有所上升，但在医生有可能积累阴道臀位分娩经验的中心，选择性阴道臀位分娩仍被广泛应用。足月时最常用的纠正非头位的方法是外倒转术。它可降低分娩时非头位的发生率，从而减少剖宫产的数量。目前，考虑到产科指征和标准，尚无足够证据支持剖宫产作为早产和足月臀位分娩的首选方式。对于每位孕妇，选择阴道分娩还是剖宫产应因人而异。
