University of Helsinki, Helsinki, Finland.
Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland.
BMC Pregnancy Childbirth. 2022 Mar 16;22(1):211. doi: 10.1186/s12884-022-04547-9.
In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries.
A retrospective register-based study.
Maternity hospitals in Finland, 2004-2017.
The study population included 762 preterm breech deliveries at 32 + 0-36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section.
The study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes.
Neonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes.
A five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08-5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40-0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33-0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19-0.48).
Vaginal breech labor at 32 + 0-36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.
在许多国家，足月阴道臀位分娩是某些情况下的选择。然而，早产阴道臀位分娩的安全性仍不清楚。因此，我们的研究旨在评估晚期早产阴道臀位分娩的安全性。
回顾性基于登记的研究。
芬兰的妇产医院，2004-2017 年。
根据分娩方式，研究人群包括 762 例 32+0-36+6 孕周的早产臀位分娩，其中 535 例（70.2%）阴道分娩，227 例（29.8%）非紧急剖宫产。
本研究比较了 32+0 至 36+6 孕周时阴道臀位分娩与非紧急剖宫产分娩的短期新生儿不良结局。采用比值比（OR）及其 95%置信区间（CI）来估计不良结局的相对风险。
新生儿死亡、脐动脉血 pH 值低于 7、5 分钟 Apgar 评分低于 4 分和 7 分、新生儿重症监护病房收治、新生儿插管、新生儿抗生素治疗、新生儿出生创伤、呼吸窘迫综合征、新生儿惊厥、脑缺血、缺氧缺血性脑病、先天性张力减退、严重不良结局的复合指标。
与非紧急剖宫产相比，32+0 至 36+6 孕周阴道臀位分娩的 5 分钟 Apgar 评分低于 7 分的发生率增加（OR 2.48，95%CI 1.08-5.59）。与非紧急剖宫产相比，阴道臀位分娩后的新生儿抗生素治疗、新生儿重症监护病房收治和新生儿呼吸窘迫综合征发生率降低（新生儿抗生素治疗 OR 0.60，95%CI 0.40-0.89；新生儿 NICU 收治 OR 0.47，95%CI 0.33-0.68；呼吸窘迫综合征 OR 0.30，95%CI 0.19-0.48）。
与剖宫产相比，32+0-36+6 孕周阴道臀位分娩不会增加新生儿短期严重发病率或死亡率。
