Deutsch Aaron, Salihu Hamisu M, Lynch O'Neill, Marty Phillip J, Belogolovkin Victoria
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL 33606, USA.
J Matern Fetal Neonatal Med. 2011 May;24(5):713-7. doi: 10.3109/14767058.2010.516287. Epub 2010 Sep 14.
To determine if cesarean delivery is associated with improved survival and morbidity in the breech fetus at the threshold of viability.
The Missouri maternally linked cohort data files covering the period 1989 through 2005 were utilized for analysis. All pregnancies with singleton fetuses in the breech presentation delivered between 23(0) and 24(6) weeks gestation and birth weights between 400 and 750 g were included. Logistic regression was used to compare cesarean to vaginal delivery after controlling for maternal demographics and pregnancy complications.
A total of 325 breech singletons were analyzed; cesarean deliveries accounted for 46.1% (150) and vaginal deliveries accounted for 53.9% (175). Cesarean delivery was associated with a survival benefit across all birth weights. Morbidity was higher in cesarean compared to vaginal delivery.
Although cesarean delivery appears to be associated with an increase in survival at the threshold of viability for the breech fetus, there is a concomitant increase in morbidity. Any benefit that cesarean delivery conveys on survival at the threshold of viability should be weighed against the increased maternal morbidity and high overall neonatal morbidity.
确定在胎儿可存活临界期，剖宫产是否与臀位胎儿存活率提高及发病率降低相关。
利用密苏里州母婴关联队列数据文件进行分析，该数据涵盖1989年至2005年期间。纳入所有妊娠23(0)至24(6)周、单胎臀位分娩且出生体重在400至750克之间的孕妇。在控制产妇人口统计学特征和妊娠并发症后，采用逻辑回归比较剖宫产与阴道分娩。
共分析了325例单胎臀位分娩；剖宫产占46.1%（150例），阴道分娩占53.9%（175例）。剖宫产与所有出生体重的存活获益相关。剖宫产的发病率高于阴道分娩。
尽管剖宫产似乎与臀位胎儿可存活临界期的存活率提高相关，但发病率也随之增加。剖宫产在可存活临界期对存活率的任何益处都应与产妇发病率增加和总体新生儿发病率较高相权衡。
