Paul B, Möllmann C J, Kielland-Kaisen U, Schulze S, Schaarschmidt W, Bock N, Brüggmann D, Louwen F, Jennewein L
Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:594-598. doi: 10.1016/j.ejogrb.2020.04.030. Epub 2020 Apr 15.
To compare the neonatal and maternal outcomes as well as the mode of delivery of intended vaginal breech deliveries in women with a prior cesarean section to primiparous patients.
The prospective monocenter cohort study was conducted among 604 women who presented for an intended vaginal singleton breech delivery at term between January 2007 and December 2016.
Out of 37 women with a prior cesarean 19 had a successful vaginal delivery. 344 of 567 primiparous women had a successful vaginal delivery. Neonatal morbidity and mortality as well as maternal outcome were not significantly different in successful vaginal deliveries of women with prior cesarean compared to primiparous patients. The cesarean section rate was not significantly higher in the group of women with a prior cesarean (49%) compared to the group of primipara (39%).
A prior cesarean should not be taken as an exclusion criterion for a planned vaginal delivery out of a breech presentation at term. Large multicenter, case-controlled studies are necessary to implement international guidelines.
比较有剖宫产史的孕妇与初产妇足月计划经阴道臀位分娩的新生儿及产妇结局以及分娩方式。
对2007年1月至2016年12月期间604例足月计划经阴道单胎臀位分娩的妇女进行前瞻性单中心队列研究。
37例有剖宫产史的妇女中，19例经阴道成功分娩。567例初产妇中有344例经阴道成功分娩。有剖宫产史的妇女经阴道成功分娩与初产妇相比，新生儿发病率和死亡率以及产妇结局无显著差异。有剖宫产史的妇女组剖宫产率（49%）与初产妇组（39%）相比无显著升高。
既往剖宫产不应作为足月臀位计划经阴道分娩的排除标准。需要开展大型多中心病例对照研究以实施国际指南。
