经颅外倒转术试产成功的预测因素：946 例女性的回顾性队列研究。

Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women.

机构信息

Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Am J Perinatol. 2023 Nov;40(15):1679-1686. doi: 10.1055/s-0041-1739505. Epub 2021 Nov 14.

DOI:10.1055/s-0041-1739505

PMID:34775580

Abstract

OBJECTIVE

Our aim was to find the factors which predict a vertex presentation of vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV).

STUDY DESIGN

This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis.

RESULTS

A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI]: 3.90-7.52, < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12-0.37, < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI: 1.03-2.92, = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model ( = 0.836).

CONCLUSION

Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor.

KEY POINTS

· The goal of ECV is to achieve a vertex VD.. · Predictors for ECV success might not predict a VD.. · Parity & AFI independently predict a VD after ECV..

摘要

目的

本研究旨在寻找在因试产外部胎儿倒转术（ECV）而入院的产妇中，预测阴道分娩（VD）呈头位的因素。

研究设计

这是一项回顾性队列研究，纳入了 2011 年 11 月至 2018 年 12 月在一家三级中心接受 ECV 试产并分娩的妇女。主要结局指标为胎儿呈头位成功进行 VD。比较成功呈头位分娩或行剖宫产的产妇，比较各种预测因素。报告不良新生儿和产妇结局。采用多变量分析进行 logistic 回归。

结果

共纳入 946 名妇女；717 名（75.8%）妇女 ECV 成功，663 名（70.1%）妇女 VD 呈头位。经产妇 VD 率为 79.3%（570/719），初产妇 VD 率为 41.0%（93/227）。羊水指数（AFI）为 50-79、80-200 和>200mm 的妇女 VD 率分别为 34.8%、71.0%和 83.1%。经产妇与初产妇相比，调整后的优势比（aOR）为 5.42（95%置信区间[CI]：3.90-7.52， <0.001），AFI 为 50-79mm 的妇女与 AFI 为 80-200mm 的妇女相比，aOR 为 0.21（95%CI 0.12-0.37， <0.001），AFI>200mm 的妇女与 AFI 为 80-200mm 的妇女相比，aOR 为 1.74（95%CI：1.03-2.92， = 0.037）。报道了基于 ECV 入院数据的 VD 发生几率的最终预测模型。Hosmer-Lemeshow 检验用于评估模型拟合优度（ = 0.836）。