Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Int J Gynaecol Obstet. 2017 Dec;139(3):324-328. doi: 10.1002/ijgo.12312. Epub 2017 Sep 22.
To determine whether repeat external cephalic version (ECV) with spinal anesthesia affects clinical outcomes and cesarean delivery rates.
A retrospective study was conducted using data collected at one hospital in Israel between January 1, 2009, and December 31, 2015. Women with non-vertex singleton pregnancies (≥37 weeks) who had a failed ECV attempt without spinal anesthesia were included in the analysis. All women were offered a repeat ECV with spinal anesthesia. Outcomes assessed were rates of vertex presentation at delivery, successful repeat ECV, and cesarean delivery.
Overall, 145 of 213 ECV attempts without spinal anesthesia were successful. Of the 68 women with a failed attempt, 5 (7%) experienced spontaneous version and 18 (26%) delivered at another institution or went into spontaneous labor. Among the remaining 45 women, 28 (62%) agreed to a repeat ECV with spinal anesthesia; 11 (39%) of these procedures were successful. All 11 women experienced vertex presentation at delivery versus none of the 17 women who refused repeat ECV (P=0.003). The cesarean delivery rate was 64% (18/28) versus 100% (17/17), respectively (P=0.007).
Repeat ECV with spinal anesthesia after a failed first attempt without spinal anesthesia increased vertex presentation at birth and decreased the rate of cesarean delivery.
确定在外周性经皮子宫外倒转术（ECV）失败后再次使用椎管内麻醉是否会影响临床结局和剖宫产率。
这是一项回顾性研究，使用以色列一家医院在 2009 年 1 月 1 日至 2015 年 12 月 31 日期间收集的数据进行分析。研究纳入了未使用椎管内麻醉的非头位单胎妊娠（≥37 周）且首次 ECV 失败的女性。所有女性均被提供椎管内麻醉下的再次 ECV。评估的结局包括分娩时头位的比例、再次 ECV 成功的比例和剖宫产的比例。
总的来说，在未使用椎管内麻醉的 213 次 ECV 尝试中，有 145 次成功。在 68 例首次 ECV 失败的女性中，有 5 例（7%）自然转为头位，18 例（26%）在其他机构分娩或自发临产。在其余 45 例女性中，有 28 例（62%）同意再次接受椎管内麻醉的 ECV；其中 11 例（39%）成功。所有 11 例均在分娩时转为头位，而 17 例拒绝再次 ECV 的女性无一例转为头位（P=0.003）。剖宫产率分别为 64%（18/28）和 100%（17/17）（P=0.007）。
在外周性经皮子宫外倒转术首次尝试失败后再次使用椎管内麻醉可增加分娩时的头位比例，降低剖宫产率。
