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足月未产妇臀位外倒转术加或不加脊髓镇痛:一项随机对照试验

External cephalic version for breech presentation with or without spinal analgesia in nulliparous women at term: a randomized controlled trial.

作者信息

Weiniger Carolyn F, Ginosar Yehuda, Elchalal Uriel, Sharon Einav, Nokrian Malka, Ezra Yossef

机构信息

Department of Anesthesiology, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.

出版信息

Obstet Gynecol. 2007 Dec;110(6):1343-50. doi: 10.1097/01.AOG.0000295605.38175.7b.

Abstract

OBJECTIVE

To compare the success of external cephalic version using spinal analgesia with no analgesia among nulliparas.

METHODS

A prospective randomized controlled trial was performed in a tertiary referral center delivery suite. Nulliparous women at term requesting external cephalic version for breech presentation were randomized to receive spinal analgesia (7.5 mg bupivacaine) or no analgesia before the external cephalic version. An experienced obstetrician performed the external cephalic version. Primary outcome was successful conversion to vertex presentation.

RESULTS

Seventy-four women were enrolled, and 70 analyzed (36 spinal, 34 no analgesia). Successful external cephalic version occurred among 24 of 36 (66.7%) women randomized to receive spinal analgesia compared with 11 of 34 (32.4%) without, P=.004 (95% confidence interval [CI] of the difference: 0.0954-0.5513). External cephalic version with spinal analgesia resulted in a lower visual analog pain score, 1.76+/-2.74 compared with 6.84+/-3.08 without, P<.001. A secondary analysis logistic regression model demonstrated that the odds of external cephalic version success was 4.0-fold higher when performed with spinal analgesia P=.02 (95% CI, odds ratio [OR] 1.2-12.9). Complete breech presentation before attempting external cephalic version increased the odds of success 8.2-fold, P=.001 (95% CI, OR 2.2-30.3). Placental position, estimated fetal weight, and maternal weight did not contribute to the success rate when spinal analgesia was used. There were no cases of placental abruption or fetal distress.

CONCLUSION

Administration of spinal analgesia significantly increases the success rate of external cephalic version among nulliparous women at term, which allows possible normal vaginal delivery.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00119184

LEVEL OF EVIDENCE

I.

摘要

目的

比较初产妇在实施外倒转术时使用脊髓镇痛与不使用镇痛的成功率。

方法

在一家三级转诊中心的分娩室进行一项前瞻性随机对照试验。足月臀位初产妇若要求进行外倒转术,则被随机分为两组,一组在进行外倒转术前接受脊髓镇痛(7.5毫克布比卡因),另一组不接受镇痛。由一位经验丰富的产科医生实施外倒转术。主要结局指标是成功转为头先露。

结果

共纳入74名女性,70名女性纳入分析(36名接受脊髓镇痛,34名未接受镇痛)。随机接受脊髓镇痛的36名女性中有24名(66.7%)外倒转术成功,而未接受镇痛的34名女性中有11名(32.4%)成功,P = 0.004(差异的95%置信区间[CI]:0.0954 - 0.5513)。使用脊髓镇痛进行外倒转术导致视觉模拟疼痛评分更低,分别为1.76±2.74和6.84±3.08,P < 0.001。一项二次分析逻辑回归模型显示,使用脊髓镇痛进行外倒转术成功的几率高4.0倍,P = 0.02(95% CI,优势比[OR] 1.2 - 12.9)。在尝试外倒转术前完全臀位增加成功几率8.2倍,P = 0.001(95% CI,OR 2.2 - 30.3)。当使用脊髓镇痛时,胎盘位置、估计胎儿体重和产妇体重对成功率无影响。未发生胎盘早剥或胎儿窘迫病例。

结论

对足月初产妇实施脊髓镇痛可显著提高外倒转术的成功率,从而使正常阴道分娩成为可能。

临床试验注册

ClinicalTrials.gov,www.clinicaltrials.gov,NCT00119184

证据级别

I级

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