Suen Stephen Sik Hung, Khaw Kim S, Law Lai Wa, Sahota Daljit Singh, Lee Shara Wee Yee, Lau Tze Kin, Leung Tak Yeung
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, PR China.
J Matern Fetal Neonatal Med. 2012 Jun;25(6):719-22. doi: 10.3109/14767058.2011.589931. Epub 2011 Nov 1.
To compare the forces exerted during external cephalic version (ECV) on the maternal abdomen between ( 1 ) the primary attempts performed without spinal analgesia (SA), which failed and ( 2 ) the subsequent reattempts performed under SA.
Patients with an uncomplicated singleton breech-presenting pregnancy suitable for ECV were recruited. During ECV, the operator wore a pair of gloves, which had thin piezo-resistive pressure sensors measuring the contact pressure between the operator's hands and maternal abdomen. For patients who had failed ECV, reattempts by the same operator was made with patients under SA, and the applied force was measured in the same manner. The profile of the exerted forces over time during each attempt was analyzed and denoted by pressure-time integral (PTI: mmHg sec). Pain score was also graded by patients using visual analogue scale. Both PTI and pain score before and after the use of SA were then compared.
Overall, eight patients who had a failed ECV without SA underwent a reattempt with SA. All of them had successful version and the median PTI of the successful attempts under SA were lower than that of the previous failed attempts performed without SA (127 386 mmHg sec vs. 298,424 mmHg sec; p = 0.017). All of them also reported a 0 pain score, which was significantly lower than that of before (median 7.5; p = 0.016).
SA improves the success rate of ECV as well as reduces the force required for successful version.
比较（1）未使用脊髓镇痛（SA）进行的首次外倒转术（ECV）尝试失败后，与（2）随后在SA下进行的再次尝试过程中，施加于孕妇腹部的力量。
招募适合进行ECV的单胎臀位妊娠且无并发症的患者。在ECV过程中，操作者佩戴一副带有薄压阻式压力传感器的手套，以测量操作者双手与孕妇腹部之间的接触压力。对于ECV失败的患者，由同一名操作者在患者处于SA状态下进行再次尝试，并以相同方式测量施加的力。分析每次尝试过程中随时间施加的力的情况，并用压力-时间积分（PTI：mmHg·秒）表示。患者还使用视觉模拟量表对疼痛程度进行评分。然后比较使用SA前后的PTI和疼痛评分。
总体而言，8例未使用SA的ECV失败患者接受了SA下的再次尝试。所有患者均成功完成倒转，SA下成功尝试的PTI中位数低于之前未使用SA的失败尝试（127386 mmHg·秒对298424 mmHg·秒；p = 0.017）。所有患者报告的疼痛评分为0分，明显低于之前（中位数7.5；p = 0.016）。
SA提高了ECV的成功率，并降低了成功倒转所需的力量。
