Boujenah J, Fleury C, Bonneau C, Pharisien I, Tigaizin A, Carbillon L
Department of Obstetrics, Gynaecology and Reproductive Medicine, hôpitaux universitaires Paris Seine Saint-Denis, Assistance publique-Hôpitaux de Paris, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH, université Paris 13, Sorbonne Paris Cité, 93140 Bobigny, France.
Department of Obstetrics, Gynaecology and Reproductive Medicine, hôpitaux universitaires Paris Seine Saint-Denis, Assistance publique-Hôpitaux de Paris, avenue du 14-Juillet, 93140 Bondy, France.
J Gynecol Obstet Hum Reprod. 2017 Dec;46(10):737-742. doi: 10.1016/j.jogoh.2017.09.001. Epub 2017 Sep 22.
To assess the mode of delivery and Caesarean Section (CS) rate after successful External Cephalic Version (ECV).
A matched case-control study. Data were gathered from a tertiary care university hospital register from 1996-2015. All pregnant women who delivered after successful External Cephalic Version (ECV). Among 643 women who attempted ECV, we identified 198 with successful ECVs and compared them with the next two women who presented for labor management with spontaneous cephalic presentation, matching for delivery date, maternal age, parity, body mass index, and delivery history using univariate and stepwise logistic regression. The main outcome measure was the risk of caesarean.
The caesarean section rate was higher after successful ECV (respectively 20.7% versus 7.07%, P<0.05). Caesarean section for abnormal fetal head position (forehead, bregma, face) was higher after successful ECV (28.6% versus 0%). After adjustment for matching and confounding variables (variation of the caesarean section rate over the study period, gestational maternal complications, antepartum fetal complications, term of delivery, induction of labor, oxytocin use for dystocia, neonatal cephalic perimeter), a successful ECV increased the risk of caesarean section (adjusted OR 3.17, 95% CI 1.86-5.46). By stratifying on week, a trend for increased risk for caesarean section was observed at the week after ECV and at post term (28.6% before 37+6, 14.8% at 38+0-38+6, 13.8% at 39+0-39+6, 14.2% at 40+0-40+6 and 33.3% beyond 41+0 weeks' gestation, P=0.06).
Women who have a successful ECV are at increased risk of caesarean section compared with women who experience spontaneous cephalic presentation.
评估外倒转术（ECV）成功后的分娩方式及剖宫产（CS）率。
一项匹配病例对照研究。数据收集自一所三级护理大学医院1996年至2015年的登记册。所有外倒转术（ECV）成功后分娩的孕妇。在643例尝试外倒转术的女性中，我们确定了198例ECV成功的女性，并将她们与接下来两名自然头先露前来分娩管理的女性进行比较，根据分娩日期、产妇年龄、产次、体重指数和分娩史进行匹配，采用单因素和逐步逻辑回归分析。主要结局指标是剖宫产风险。
ECV成功后剖宫产率较高（分别为20.7%对7.07%，P<0.05）。ECV成功后因异常胎头位置（额头、前囟、面部）进行剖宫产的比例较高（28.6%对0%）。在对匹配和混杂变量（研究期间剖宫产率的变化、孕期产妇并发症、产前胎儿并发症、分娩孕周、引产、因难产使用缩宫素、新生儿头围）进行调整后，ECV成功增加了剖宫产风险（调整后的比值比为3.17，95%可信区间为1.86 - 5.46）。按孕周分层，在ECV后一周及过期妊娠时观察到剖宫产风险增加的趋势（妊娠37 + 6周前为28.6%，38 + 0至38 + 6周为14.8%，39 + 0至39 + 6周为13.8%，40 + 0至40 + 6周为14.2%，妊娠41 + 0周后为33.3%，P = 0.06）。
与自然头先露的女性相比，外倒转术（ECV）成功的女性剖宫产风险增加。
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