FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany.
PLoS One. 2018 Aug 23;13(8):e0202760. doi: 10.1371/journal.pone.0202760. eCollection 2018.
The clinical management of breech presentations at term is still a controversially discussed issue among clinicians. Clear predictive criteria for planned vaginal breech deliveries are desperately needed to prevent adverse fetal and maternal outcomes and to reduce elective cesarean section rates. The green-top guideline considers an estimated birth weight of 3.8 kg or more an indication to plan a cesarean section despite the lack of respective evidence.
To compare maternal and neonatal outcome of vaginal intended breech deliveries of births with children with a birth weight of 2.5 kg- 3.79 kg and children with a birth weight of 3.8 kg and more.
Prospective cohort study.
All vaginal intended deliveries out of a breech position of newborns weighing between 2.5 kg and 4.5 kg at the Obstetrics department at Goethe University Hospital Frankfurt from January 2004 until December 2016.
Neonatal and maternal outcome of a light weight group (LWG) (< 3.8 kg) was compared to and a high weight group (HWG) (≥ 3.8 kg) using Pearson's Chi Square test and Fishers exact test. A logistic regression analysis was performed to detect an association between cesarean section rates, fetal outcome and the birth weight.
No difference in neonatal morbidity was detected between the HWG (1.8%, n = 166) and the LWG (2.6%, n = 888). Cesarean section rate was significantly higher in the HWG with 45.2% in comparison to 28.8% in the LWG with an odds ratio of 1.57 (95% CI 1.29-1.91, p<0.0001). In vaginal deliveries, a high birth weight was not associated with an increased risk of maternal birth injuries (LWG in vaginal deliveries: 74.3%, HWG in vaginal deliveries: 73.6%; p = 0.887; OR = 1.9 (95% CI 0.9-1.1)).
A fetal weight above 3.79 kg does not predict increased maternal or infant morbidity after delivery from breech presentation at term. Neither the literature nor our analyses document evidence for threshold of estimated birth weight that is associated with maternal and/or infant morbidity. However, patients should be informed about an increased likelihood of cesarean sections during labor when attempting vaginal birth from breech position at term in order to reach an informed shared decision concerning the birth strategy. Further investigations in multi center settings are needed to advance international guidelines on vaginal breech deliveries in the context of estimated birth weight and its impact on perinatal outcome.
在足月时臀位分娩的临床管理仍然是临床医生之间有争议的问题。迫切需要明确预测计划阴道臀位分娩的标准，以防止胎儿和产妇不良结局，并降低选择性剖宫产率。绿顶指南认为，即使缺乏相应的证据，估计体重 3.8 公斤或以上也是计划剖宫产的指征。
比较体重 2.5 公斤至 3.79 公斤的新生儿阴道分娩和体重 3.8 公斤及以上新生儿阴道分娩的母婴结局。
前瞻性队列研究。
2004 年 1 月至 2016 年 12 月，法兰克福歌德大学医院妇产科所有从臀位分娩的新生儿体重在 2.5 公斤至 4.5 公斤之间的阴道分娩。
使用 Pearson's Chi Square 检验和 Fisher's exact 检验比较低体重组（LWG）（<3.8 公斤）和高体重组（HWG）（≥3.8 公斤）的新生儿和产妇结局。进行逻辑回归分析以检测剖宫产率、胎儿结局和体重之间的关联。
HWG（1.8%，n=166）和 LWG（2.6%，n=888）之间的新生儿发病率无差异。HWG 的剖宫产率明显高于 LWG，分别为 45.2%和 28.8%，优势比为 1.57（95%CI 1.29-1.91，p<0.0001）。在阴道分娩中，高出生体重与产妇分娩损伤的风险增加无关（LWG 在阴道分娩中：74.3%，HWG 在阴道分娩中：73.6%；p=0.887；OR=1.9（95%CI 0.9-1.1））。
足月时胎儿体重超过 3.79 公斤并不会增加臀位分娩后的母婴发病率。文献和我们的分析都没有证明估计出生体重与母婴发病率相关的阈值存在证据。然而，当试图从足月臀位阴道分娩时，应该告知患者在分娩期间行剖宫产的可能性增加，以便就分娩策略达成知情共享决策。需要在多中心环境中进行进一步的调查，以推进国际关于阴道臀位分娩的指南，包括估计出生体重及其对围产期结局的影响。
