Sheba Medical Center at Tel Hashomer, Tel HaShomer, Israel.
Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
J Matern Fetal Neonatal Med. 2020 May;33(9):1554-1560. doi: 10.1080/14767058.2018.1523388. Epub 2018 Nov 4.
: Women may be unaware of the potential impact on subsequent deliveries of the decision to undergo primary breech cesarean (PBC) delivery rather than attempt external cephalic version (ECV). We investigated cesarean delivery rates and adverse maternal outcomes in the subsequent delivery following management of breech presentation by ECV versus PBC. This retrospective study identified women who delivered subsequent to breech presentation managed by attempted ECV or PBC. We assessed cesarean delivery rates and adverse maternal outcomes including hemorrhage, placental complications, infection, and obstetric complications in the subsequent delivery following attempted ECV versus PBC. We identified 307 women who had attempted ECV and 508 with PBC in the index breech pregnancy. Following attempted ECV, 47 (15.3%) women had cesarean delivery in the subsequent pregnancy versus 246 (48.4%) following PBC, adjusted OR 0.24, 95% CI 0.16-0.35 for subsequent cesarean delivery after attempted ECV in the index pregnancy. The frequency of composite adverse outcomes related to cesarean delivery was 30 (9.8%) following attempted ECV versus 104 (20.5%) after PBC, < .0001. The frequency of composite severe adverse maternal outcome was similar following attempted ECV 25 (8.8%) versus PBC 59 (11.9%). The current study suggests that attempted external cephalic version was associated with a five-fold decrease risk to undergo cesarean in the subsequent delivery and a significantly decreased frequency of composite adverse outcomes related to cesarean delivery in the subsequent delivery.
: 女性可能没有意识到选择行初次臀位剖宫产（PBC）而非尝试外倒转术（ECV）对后续分娩的潜在影响。我们研究了在管理臀位分娩时，通过 ECV 与 PBC 处理，后续分娩行剖宫产的比率和不良母婴结局。这项回顾性研究确定了在尝试 ECV 或 PBC 处理臀位分娩后分娩的女性。我们评估了 ECV 与 PBC 处理后尝试 ECV 与 PBC 处理后行剖宫产的比率和不良母婴结局，包括产后出血、胎盘并发症、感染和产科并发症。我们确定了 307 例尝试 ECV 分娩的女性和 508 例 PBC 分娩的女性。在尝试 ECV 后，47 例（15.3%）女性在后续妊娠中行剖宫产，而在 PBC 后，246 例（48.4%），调整后 OR 0.24，95%CI 0.16-0.35，在指数妊娠中尝试 ECV 后后续行剖宫产。与剖宫产相关的复合不良结局的发生率在尝试 ECV 后为 30 例（9.8%），而在 PBC 后为 104 例（20.5%），<0.0001。尝试 ECV 后复合严重不良母婴结局的发生率为 25 例（8.8%），而 PBC 后为 59 例（11.9%）。本研究表明，尝试外倒转术与后续分娩行剖宫产的风险降低五倍相关，且与剖宫产相关的复合不良结局的发生率也显著降低。
