Toivonen Elli, Palomäki Outi, Korhonen Päivi, Huhtala Heini, Uotila Jukka
School of Medicine, University of Tampere, Tampere, Finland.
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
Eur J Obstet Gynecol Reprod Biol. 2018 Jun;225:13-18. doi: 10.1016/j.ejogrb.2018.03.054. Epub 2018 Mar 30.
To compare neonatal and maternal outcomes in spontaneously onset preterm breech deliveries after trial of labor (BTOL) and intended cesarean section (BCS), and between BTOL and vertex control deliveries, in singleton fetuses at 32-36 weeks of gestation.
Retrospective single center cohort study in a Finnish University Hospital including all spontaneous-onset preterm breech deliveries with 32 completed gestational weeks in 2003-2015. The study population comprised a total of 176 preterm breech and 103 vertex control deliveries, matched by gestational age and whether the mother had given birth vaginally before or not. Infants with severe malformations and antepartum fetal distress were excluded. Subgroup analyses were made in two cohorts according to gestational age. Main outcome measures were maternal and neonatal mortality and morbidity, low cord pH and Apgar score.
No mortality was observed, and severe morbidity was rare. No difference in incidence of low cord pH or five-minute Apgar score was observed between the groups. Apgar scores at the age of one minute were comparable in the breech groups but more often low in the BTOL group compared to the vertex control group. 16.5% of neonates in the BTOL group, 23.3% in the BCS group and 7.8% in the vertex group needed intensive care. In logistic regression analysis, lower gestational age and being small for gestational age were associated with the need for neonatal intensive care. Being allowed a trial of labor was not associated with the need for neonatal intensive care. Maternal morbidity was similar across the groups, but median blood loss was more pronounced in the BCS group compared to the BTOL group.
In breech deliveries at 32-36 gestational weeks, trial of labor did not increase neonatal morbidity compared to intended cesarean delivery. Infants born after a trial of labor in breech presentation display low one-minute Apgar score and need intensive care more often compared to vertex controls.
比较妊娠32 - 36周单胎胎儿经阴道试产（BTOL）与计划剖宫产（BCS）后自然发动早产臀位分娩的新生儿及母亲结局，以及BTOL与头位对照分娩的结局。
在芬兰一家大学医院进行的回顾性单中心队列研究，纳入2003 - 2015年所有妊娠满32周的自然发动早产臀位分娩。研究人群包括176例早产臀位分娩和103例头位对照分娩，根据孕周及母亲既往是否经阴道分娩进行匹配。排除严重畸形及产前胎儿窘迫的婴儿。根据孕周对两个队列进行亚组分析。主要结局指标为母亲和新生儿死亡率及发病率、脐血pH值低及阿氏评分。
未观察到死亡病例，严重发病率罕见。两组间脐血pH值低或5分钟阿氏评分的发生率无差异。臀位组1分钟时的阿氏评分相当，但与头位对照组相比，BTOL组1分钟时阿氏评分较低的情况更常见。BTOL组16.5%的新生儿、BCS组23.3%的新生儿及头位组7.8%的新生儿需要重症监护。在逻辑回归分析中，孕周较小及小于胎龄与新生儿重症监护需求相关。经阴道试产与新生儿重症监护需求无关。各组母亲发病率相似，但与BTOL组相比，BCS组的中位失血量更显著。
在妊娠32 - 36周的臀位分娩中，与计划剖宫产相比，经阴道试产并未增加新生儿发病率。与头位对照分娩相比，臀位经阴道试产后出生的婴儿1分钟阿氏评分较低，且更常需要重症监护。
