Department of Obstetrics and Gynecology, Rambam Health Care Campus, and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Obstet Gynecol. 2021 Feb 1;137(2):258-262. doi: 10.1097/AOG.0000000000004231.
To evaluate a possible correlation between a new variable-persistent breech presentation-and the success rate of external cephalic version (ECV).
This was a retrospective study of ECVs performed from January 2008 through January 2019 in an Israeli tertiary care hospital. The study group included all pregnant women who underwent an ECV at or beyond 37 weeks of gestation. Persistent breech presentation was defined as persistent breech presentation during all ultrasound examinations performed between the anatomy scan at mid-pregnancy and the gestational week when ECV was attempted. Women in whom cephalic presentation was documented at least once on these ultrasound examinations were defined as not having persistent breech presentation. The primary outcome was defined as the success rate of ECV, and the secondary outcome was defined as the mode of delivery after a successful ECV.
We identified 1,271 women with breech presentation during the study period. They had undergone median of five (range 2-7) ultrasound examinations. External cephalic version was attempted in 684 women (53.8%), with a success rate of 61.5%. External cephalic version succeeded in 19.6% of those with persistent breech presentation (44/224) compared with 82.0% (377/460) of those without persistent breech presentation (P<.001). Ultimately, women with persistent breech presentation and successful ECV experienced a lower rate of vaginal delivery (27.3% vs 79%, P<.001), and a higher rate of instrumental (29% vs 13%, P<.001) and cesarean deliveries (43% vs 7%, P<.001) compared with the nonpersistent breech presentation group. The rate of noninstrumental vaginal delivery among women with persistent breech presentation, regardless of ECV, was 5.4%.
Women with persistent breech presentation experienced a high rate of ECV failure and a low rate of spontaneous vaginal delivery.
评估一种新的可变持续性臀位分娩与外部胎儿头位倒转术（ECV）成功率之间可能存在的相关性。
这是一项回顾性研究，纳入了 2008 年 1 月至 2019 年 1 月期间在以色列一家三级保健医院进行的 ECV。研究组包括所有在妊娠 37 周及以上进行 ECV 的孕妇。持续性臀位分娩的定义为中孕期的解剖扫描至尝试 ECV 的妊娠周期间所有超声检查中持续性臀位分娩。至少一次在这些超声检查中记录为头位分娩的孕妇被定义为没有持续性臀位分娩。主要结局定义为 ECV 的成功率，次要结局定义为成功 ECV 后的分娩方式。
我们在研究期间确定了 1271 例臀位分娩的孕妇。她们进行了中位数为 5 次（范围 2-7 次）的超声检查。684 例孕妇（53.8%）尝试了 ECV，成功率为 61.5%。持续性臀位分娩的孕妇中 ECV 成功的比例为 19.6%（44/224），而无持续性臀位分娩的孕妇中 ECV 成功的比例为 82.0%（377/460）（P<.001）。最终，持续性臀位分娩且 ECV 成功的孕妇阴道分娩率较低（27.3%对 79%，P<.001），器械助产（29%对 13%，P<.001）和剖宫产（43%对 7%，P<.001）率较高。无论 ECV 结果如何，持续性臀位分娩的孕妇非器械性阴道分娩率为 5.4%。
持续性臀位分娩的孕妇 ECV 失败率高，自然阴道分娩率低。
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