Bin Yu Sun, Roberts Christine L, Ford Jane B, Nicholl Michael C
Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2016 Oct;56(5):453-459. doi: 10.1111/ajo.12488. Epub 2016 Jun 24.
Trial evidence supports a policy of caesarean section for singleton breech presentations at term, but vaginal breech birth is considered a safe option for selected women.
To provide recent Australian data on outcomes associated with intended mode of delivery for term breech singletons in women who meet conservative eligibility criteria for vaginal breech birth.
Birth and hospital records from 2009 to 2012 in New South Wales were used to identify women with nonanomalous pregnancies who would be considered eligible for vaginal breech birth. Intended mode of delivery was inferred from labour onset and management.
Of 10 133 women with term breech singleton pregnancies, 5197 (51.3%) were classified as eligible for vaginal breech delivery. Of these, 6.8% intended vaginal breech birth, 76.4% planned caesarean section and intention could not be determined for 16.8%. Women intending vaginal delivery had higher rates of neonatal morbidity (6.0% vs 2.1%), neonatal birth trauma (7.4% vs 0.9%), Apgar <4 at one minute (10.5% vs 1.1%), Apgar <7 at five minutes (4.3% vs 0.5%) and neonatal intensive care unit/special care nursery admissions (16.2% vs 6.6%) than those planning caesarean section. Increased perinatal risks remained after adjustment for maternal characteristics. Severe maternal morbidity (1.4% vs 0.7%) and post-partum readmission (4.6% vs 4.0%) were higher in the intended vaginal compared to planned caesarean births, but these differences were not statistically significant.
In a population of women classified as being eligible for vaginal breech birth, intended vaginal delivery was associated with higher rates of neonatal morbidity than planned caesarean section.
试验证据支持足月单臀先露行剖宫产的政策，但对于部分女性，阴道分娩臀位胎儿被认为是一种安全的选择。
提供近期澳大利亚关于符合阴道分娩臀位胎儿保守入选标准的女性足月单臀先露预期分娩方式相关结局的数据。
使用新南威尔士州2009年至2012年的出生和医院记录，识别非异常妊娠且被认为符合阴道分娩臀位胎儿条件的女性。预期分娩方式根据临产和处理情况推断。
在10133名单臀先露足月妊娠女性中，5197名（51.3%）被分类为符合阴道分娩臀位胎儿条件。其中，6.8%预期经阴道分娩臀位胎儿，76.4%计划剖宫产，16.8%的分娩意向无法确定。与计划剖宫产的女性相比，预期经阴道分娩的女性新生儿发病率（6.0%对2.1%）、新生儿产伤（7.4%对0.9%）、1分钟时阿氏评分<4分（10.5%对1.1%）、5分钟时阿氏评分<7分（4.3%对0.5%）以及新生儿重症监护病房/特殊护理病房收治率（16.2%对6.6%）更高。在对产妇特征进行调整后，围产期风险仍然增加。预期经阴道分娩与计划剖宫产相比，严重孕产妇发病率（1.4%对0.7%）和产后再入院率（4.6%对4.0%）更高，但这些差异无统计学意义。
在被分类为符合阴道分娩臀位胎儿条件的女性群体中，预期经阴道分娩与比计划剖宫产更高的新生儿发病率相关。
