Hills Frances, Way Mandy, Sekar Renuka
Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
Aust N Z J Obstet Gynaecol. 2018 Apr;58(2):178-184. doi: 10.1111/ajo.12681. Epub 2017 Aug 11.
Preterm breech delivery is associated with a higher perinatal mortality rate compared with preterm vertex delivery, and some studies suggest caesarean section leads to lower mortality rates. Few studies include infants delivered less than 26 weeks gestation, and where included, results are often not stratified by gestational age. There is also a lack of consistent reporting on neonatal and maternal morbidity outcome measures.
To determine if mode of delivery for singleton extreme preterm breech fetuses is associated with a difference in perinatal mortality, neonatal and maternal morbidity.
Retrospective cohort study of breech deliveries from 23 + 0 to 27 + 6 weeks gestation (extreme preterm) between 2005 and 2014 at a tertiary obstetric facility.
One hundred and fifty deliveries met the selection criteria. Perinatal mortality was reduced in the caesarean section group (20% vs 55.5% P < 0.001). Apgar scores ≥ 7 (P = 0.008) and cord pH ≥7.1 (P = 0.025) were more likely for neonates delivered by caesarean section, with lower rates of birth trauma (P = 0.003). Caesarean section was associated with higher nursery admission rates (P < 0.001), longer intensive care nursery admission (P = 0.006), continuous positive airway pressure times (P = 0.008) and increased use of surfactant (P < 0.001). Maternal morbidity was increased with caesarean section including longer hospital stay (P < 0.001), higher postpartum haemorrhage (P < 0.001) and wound infection rates (P = 0.034).
Caesarean section for singleton extreme preterm breech delivery is associated with reduced perinatal mortality, improved neonatal condition at delivery, and increased short-term maternal morbidity.
与早产头位分娩相比，早产臀位分娩的围产期死亡率更高，一些研究表明剖宫产可降低死亡率。很少有研究纳入孕周小于26周的婴儿，即便纳入，结果也往往未按孕周分层。此外，关于新生儿和产妇发病率结局指标的报告也缺乏一致性。
确定单胎极早早产臀位胎儿的分娩方式是否与围产期死亡率、新生儿和产妇发病率的差异相关。
对2005年至2014年在一家三级产科机构进行的孕周为23+0至27+6周（极早早产）的臀位分娩进行回顾性队列研究。
150例分娩符合入选标准。剖宫产组的围产期死亡率降低（20%对55.5%，P<0.001）。剖宫产分娩的新生儿Apgar评分≥7（P=0.008）和脐血pH≥7.1（P=0.025）的可能性更大，出生创伤发生率更低（P=0.003）。剖宫产与更高的新生儿重症监护病房入住率（P<0.001）、更长的重症监护病房住院时间（P=0.006）、持续气道正压通气时间（P=0.008）以及更高的表面活性剂使用率（P<0.001）相关。剖宫产会增加产妇发病率，包括更长的住院时间（P<0.001）、更高的产后出血率（P<0.001）和伤口感染率（P=0.034）。
单胎极早早产臀位分娩行剖宫产与围产期死亡率降低、分娩时新生儿状况改善以及短期产妇发病率增加相关。
