Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Gynaecol Obstet. 2019 Apr;145(1):116-121. doi: 10.1002/ijgo.12774. Epub 2019 Feb 18.
To determine optimum timing of external cephalic version (ECV).
A retrospective cohort study was conducted at a tertiary hospital in Israel between February 1, 2016, and July 1, 2017. Healthy primiparous women with breech presentation were offered either early ECV (35-36 weeks; n=54) or late ECV (37-38 weeks; n=106). Group assignment was according to the patient's preference and physician availability. The primary outcome was the rate of cephalic presentation at delivery. Secondary outcomes included rate of cesarean delivery, presentation of fetus after the first and last ECVs, and serious fetal complications.
The incidence of undergoing more than two ECV attempts was 18.5% in the early ECV group and 5.6% in the late ECV group (P=0.039). The incidence of cephalic presentation after the first ECV was 72.2% in the early ECV group versus 66.0% in the late ECV group (P=0.048). By contrast, no statistically significant between-group differences were found for presentation at delivery or rate of cesarean delivery. The other outcomes were also similar.
Early initiation of ECV among primiparous women increased the chance of immediate cephalic presentation; however, it had no effect on presentation at delivery or cesarean delivery rate.
确定外倒转术（ECV）的最佳时机。
本研究为 2016 年 2 月 1 日至 2017 年 7 月 1 日在以色列一家三级医院进行的回顾性队列研究。对臀位的健康初产妇分别进行早期 ECV（35-36 周；n=54）或晚期 ECV（37-38 周；n=106）。分组依据是患者的意愿和医生的时间安排。主要结局是分娩时头位的比例。次要结局包括剖宫产率、第一次和最后一次 ECV 后胎儿的位置，以及严重的胎儿并发症。
早期 ECV 组中有 18.5%的患者需要进行两次以上的 ECV 尝试，而晚期 ECV 组中这一比例为 5.6%（P=0.039）。早期 ECV 组中第一次 ECV 后头位的发生率为 72.2%，而晚期 ECV 组为 66.0%（P=0.048）。相比之下，两组在分娩时的头位率或剖宫产率方面没有统计学上的显著差异。其他结局也相似。
初产妇早期进行 ECV 可增加即刻头位的机会，但对分娩时的头位率或剖宫产率没有影响。
