Indraccolo U, Graziani C, Di Iorio R, Corona G, Bonito M, Indraccolo S R
Complex Operative Unit of Gynecology and Obstetrics of Civitanova Marche, Hospital of Civitanova Marche, Area Vasta 3, Marche, Italy.
Eur Rev Med Pharmacol Sci. 2015 Jul;19(13):2340-53.
External cephalic version (ECV) for breech presentation is not routinely performed by obstetricians in many clinical settings. The aim of this work is to assess to what extent the factors involved in performing ECV are relevant for the success and safety of ECV, in order to propose a practical check-list for assessing the feasibility of ECV.
Review of 214 references. Factors involved in the success and risks of ECV (feasibility of ECV) were extracted and were scored in a semi-quantitative way according to textual information, type of publication, year of publication, number of cases. Simple conjoint analysis was used to describe the relevance found for each factor.
Parity has the pivotal role in ECV feasibility (relevance 16.6%), followed by tocolysis (10.8%), gestational age (10.6%), amniotic fluid volume (4.7%), breech variety (1.9%), and placenta location (1.7%). Other factors with estimated relevance around 0 (regional anesthesia, station, estimated fetal weight, fetal position, obesity/BMI, fetal birth weight, duration of manoeuvre/number of attempts) have some role in the feasibility of ECV. Yet other factors, with negative values of estimated relevance, have even less importance.
From a logical interpretation of the relevance of each factor assessed, ECV should be proposed with utmost prudence if a stringent check-list is followed. Such a check-list should take into account: parity, tocolytic therapy, gestational age, amniotic fluid volume, breech variety, placenta location, regional anesthesia, breech engagement, fetal well-being, uterine relaxation, fetal size, fetal position, fetal head grasping capability and fetal turning capability.
在许多临床环境中，产科医生并不常规进行臀位外倒转术（ECV）。本研究的目的是评估实施ECV所涉及的因素在多大程度上与ECV的成功和安全性相关，以便提出一份评估ECV可行性的实用检查表。
回顾214篇参考文献。提取与ECV成功和风险（ECV可行性）相关的因素，并根据文本信息、出版物类型、出版年份、病例数进行半定量评分。采用简单联合分析来描述每个因素的相关性。
产次在ECV可行性中起关键作用（相关性为16.6%），其次是宫缩抑制剂（10.8%）、孕周（10.6%）、羊水量（4.7%）、臀位类型（1.9%）和胎盘位置（1.7%）。其他估计相关性约为0的因素（区域麻醉、胎先露、估计胎儿体重、胎儿位置、肥胖/体重指数、胎儿出生体重、操作持续时间/尝试次数）在ECV可行性中也有一定作用。然而，其他估计相关性为负值的因素重要性更低。
从对每个评估因素相关性的合理解释来看，如果遵循严格的检查表，应极其谨慎地提出ECV。这样的检查表应考虑：产次、宫缩抑制剂治疗、孕周、羊水量、臀位类型、胎盘位置、区域麻醉、臀位衔接、胎儿健康状况、子宫松弛度、胎儿大小、胎儿位置、胎儿头部抓取能力和胎儿转动能力。
