van de Pavert R, Bennebroek Gravenhorst J, Keirse M J
Academisch Ziekenhuis, afd. Verloskunde, Leiden.
Ned Tijdschr Geneeskd. 1990 Nov 17;134(46):2245-8.
We report a randomised controlled trial of external version in 52 women with breech presentation after 36 weeks' gestation; 83% gave informed consent to undergo the management to which they had been randomized. Only 5% of initial attempts without tocolysis succeeded, but 31% of the failures subsequently had a successful version under tocolysis. External version resulted in a small decrease in the frequency of breech presentation at birth (64% vs. 74%), and in an unexpected increase in the caesarean section rate (28% vs. 11%). The increase in caesarean section rate could be attributed to failed versions, which apparently greatly influenced the choice between abdominal and vaginal delivery. Our findings and data from similar research suggest that benefits of external version at term may not apply to populations with a low caesarean rate, unless versions are carried out with maximal efficiency (which, on the basis of available data, would imply tocolysis) or so indifferently that failed attempts do not influence the choice between abdominal and vaginal delivery.
我们报告了一项针对52名妊娠36周后臀位的女性进行外倒转术的随机对照试验；83%的女性知情同意接受随机分配的治疗方案。在未使用宫缩抑制剂的初次尝试中，只有5%成功，但31%初次失败的患者随后在使用宫缩抑制剂的情况下成功进行了外倒转术。外倒转术使出生时臀位的发生率略有下降（64%对74%），但剖宫产率意外升高（28%对11%）。剖宫产率的增加可能归因于外倒转术失败，这显然极大地影响了剖宫产和阴道分娩方式的选择。我们的研究结果以及类似研究的数据表明，足月外倒转术的益处可能不适用于剖宫产率较低的人群，除非外倒转术以最高效率进行（根据现有数据，这意味着使用宫缩抑制剂），或者进行得如此随意，以至于失败的尝试不会影响剖宫产和阴道分娩方式的选择。
