Lorthe Elsa, Quere Mathilde, Sentilhes Loïc, Delorme Pierre, Kayem Gilles
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, France; Sorbonne Universités, Université Pierre & Marie Curie, Institut de Formation Doctorale, Paris, France.
Inserm Unité Mixte de Recherche 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, France.
Eur J Obstet Gynecol Reprod Biol. 2017 May;212:37-43. doi: 10.1016/j.ejogrb.2017.03.019. Epub 2017 Mar 10.
To describe the incidence of breech presentation at 22-34 weeks' gestation, estimate the incidence of cesarean section delivery by cause of prematurity, and assess the factors associated with caesarean delivery in preterm breech births with preterm labor or preterm premature rupture of membranes.
EPIPAGE 2 is a French national prospective population-based cohort study of preterm births that occurred in 546 maternity units in 2011. We estimated the overall incidence of breech presentation and the incidence of cesarean delivery by cause of prematurity. Among the 579 singletons with breech presentation born at 22-34 weeks in a context of spontaneous preterm labor or membrane rupture, multivariable logistic regression was used to assess the association between individual and institutional characteristics and caesarean delivery.
Among the 3660 singletons born at 22-34 weeks' gestation in the EPIPAGE 2 study, 20.1% (n=911) were breech presentation. Among these births, the rate of cesarean section was 99.6% with vascular pathologies, intrauterine growth retardation or placental abruption as compared with 60.1% with spontaneous preterm labor or membrane rupture. The main indication for caesarean delivery was gestational age associated with breech presentation (61.0%). Delivery mode varied by region of birth. Other characteristics associated with caesarean delivery were hospital status (public teaching, public non-teaching or private), clinical chorioamniotitis, hospital admission after labor onset, and gestational age.
Breech presentation is common in preterm infants and is associated with widespread use of cesarean delivery with significant regional disparities that could reflect the lack of consensus and recommendations on the preferential mode of delivery. Other factors associated with caesarean delivery are the status of the maternity unit, clinical chorioamniotitis, admission after labor onset and gestational age.
描述妊娠22 - 34周时臀位的发生率，按早产原因估算剖宫产的发生率，并评估早产伴臀位且有早产临产或胎膜早破的剖宫产相关因素。
EPIPAGE 2是一项基于法国全国前瞻性人群的队列研究，研究对象为2011年在546个产科单位发生的早产病例。我们估算了臀位的总体发生率以及按早产原因的剖宫产发生率。在579例妊娠22 - 34周、因自发早产临产或胎膜破裂而出生的单胎臀位婴儿中，采用多变量逻辑回归评估个体和机构特征与剖宫产之间的关联。
在EPIPAGE 2研究中，妊娠22 - 34周出生的3660例单胎婴儿中，20.1%（n = 911）为臀位。在这些分娩中，因血管病变、胎儿生长受限或胎盘早剥而行剖宫产的比例为99.6%，而因自发早产临产或胎膜破裂的比例为60.1%。剖宫产的主要指征是与臀位相关的孕周（61.0%）。分娩方式因出生地区而异。与剖宫产相关的其他特征包括医院类型（公立教学医院、公立非教学医院或私立医院）、临床绒毛膜羊膜炎、临产后宫内入院以及孕周。
臀位在早产儿中很常见，且与剖宫产的广泛使用相关，存在显著的地区差异，这可能反映出在优先分娩方式上缺乏共识和建议。与剖宫产相关的其他因素包括产科单位的类型、临床绒毛膜羊膜炎、临产后宫内入院以及孕周。
