Insitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Obstetrics, Trondheim University Hospital St. Olavs, Trondheim, Norway.
Acta Obstet Gynecol Scand. 2021 Jul;100(7):1336-1344. doi: 10.1111/aogs.14083. Epub 2021 Feb 2.
There is limited evidence on the safety and outcome of induction of breech labor. In this study, we aimed to compare the outcomes of spontaneous and induced breech deliveries and to describe variations in induction rates.
This was a retrospective cohort study comprising 1054 singleton live fetuses in breech presentation at Trondheim University Hospital from 2012 to 2019. The main outcome was intrapartum cesarean section, and secondary outcomes were postpartum hemorrhage, anal sphincter ruptures, Apgar scores, pH in the umbilical artery, and metabolic acidosis. All data were obtained from the hospital birth journal.
Induction of labor was performed in 127/606 (21.0%) women with planned vaginal birth. The frequency of intrapartum cesarean section was 48.0% for induced labor vs 45.7% for spontaneous labor (P = .64). We found no differences in the frequency of postpartum hemorrhage or anal sphincter ruptures between induced and spontaneous births. The median pH in the umbilical artery was significantly lower in neonates with induced labor compared with neonates with spontaneous labor (7.22 vs 7.25; P = .02). The frequency of pH <7.05 was 7.0% for induced labor vs 2.9% (P = .05) for spontaneous labor, but the frequency of pH <7.0 was not significantly different: 2.6% vs 0.8% (P = .14), respectively. Three neonates with planned vaginal birth had metabolic acidosis: two with spontaneous labors and one with induced labor. Three fetuses with planned vaginal birth died during labor: two with spontaneous onset of labor and one with induced labor. All three were extremely preterm: two were delivered in week 23 and one in week 25. We did not observe any significant trend in induction rates in either parous or nulliparous women.
The induction rates were stable during the study period. We did not observe any significant difference in intrapartum cesarean section rates, in the frequency of pH <7.0 in the umbilical artery, or in the frequency of metabolic acidosis when comparing induced and spontaneous breech deliveries.
关于臀位分娩的安全性和结局，证据有限。本研究旨在比较自然分娩和诱导分娩的结局，并描述诱导分娩率的变化。
这是一项回顾性队列研究，纳入了 2012 年至 2019 年特隆赫姆大学医院 1054 例臀位单胎活产儿。主要结局为产时剖宫产，次要结局为产后出血、肛门括约肌破裂、新生儿 Apgar 评分、脐动脉 pH 值和代谢性酸中毒。所有数据均来自医院分娩记录。
127/606（21.0%）计划阴道分娩的产妇行引产。产时剖宫产率为诱导分娩 48.0%，自然分娩 45.7%（P=0.64）。诱导分娩与自然分娩的产后出血或肛门括约肌破裂发生率无差异。脐动脉 pH 值中位数在诱导分娩新生儿中明显低于自然分娩新生儿（7.22 对 7.25；P=0.02）。诱导分娩 pH 值<7.05 的发生率为 7.0%，自然分娩为 2.9%（P=0.05），但 pH 值<7.0 的发生率无显著差异：分别为 2.6%和 0.8%（P=0.14）。3 例计划阴道分娩的新生儿发生代谢性酸中毒：2 例为自然分娩，1 例为诱导分娩。3 例计划阴道分娩的胎儿在分娩过程中死亡：2 例为自然临产，1 例为诱导临产。所有 3 例均为极早产儿：2 例分娩于 23 周，1 例分娩于 25 周。我们未观察到经产妇或初产妇的诱导分娩率有任何显著趋势。
在研究期间，诱导分娩率保持稳定。我们未观察到诱导分娩和自然臀位分娩的产时剖宫产率、脐动脉 pH 值<7.0 的发生率或代谢性酸中毒的发生率有显著差异。
