Claire Guerini, Diane Korb, Olivier Sibony
Service de Gynécologie Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France.
Centre for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France.
Arch Gynecol Obstet. 2023 Mar;307(3):729-738. doi: 10.1007/s00404-022-06526-z. Epub 2022 Apr 27.
To assess severe neonatal morbidity and mortality in induced labor in preterm breech deliveries, compared to spontaneous labor.
This is a retrospective study conducted in a tertiary university center in France. Women with single live breech pregnancy between 28 + 0 and 36 + 6 weeks gestation were included. We excluded situations with medical contraindication to vaginal delivery and fetal malformations. We compared women with an unfavorable cervix, who had an indication for deliver and could receive cervical ripening to induce labor, to women in spontaneous labor. The primary outcome was a composite criterion of severe neonatal morbidity and mortality including perinatal death, traumatic event during delivery, Apgar score at 5-min < 4, moderate or severe encephalopathy, seizures within the first 24 h, Intra-Ventricular Hemorrhage grade 3 or 4, necrotizing enterocolitis grade 2 or 3.
We included 212 patients: 64 in the induced labor group and 136 in the spontaneous labor group. In the induced labor group, 45.3% of patients delivered vaginally, and 86% in spontaneous labor group. The neonatal morbidity and mortality rate were similar in both groups: 4.7% in the induced labor group, and 5.2% in the spontaneous labor group, p = 0.889, aOR = 1.5 (0.28-8.28).
Nearly half of the patient who received induction of labor delivered vaginally. The onset mode of labor does not appear to have an effect on severe neonatal morbidity and mortality in preterm breech fetuses. Induction of labor could be an option for patients in this setting.
与自然分娩相比，评估早产臀位分娩引产时的严重新生儿发病率和死亡率。
这是一项在法国一所三级大学中心进行的回顾性研究。纳入妊娠28 + 0至36 + 6周的单活胎臀位妊娠妇女。我们排除了阴道分娩存在医学禁忌证和胎儿畸形的情况。我们将宫颈条件不佳、有分娩指征且可接受宫颈成熟引产的妇女与自然分娩的妇女进行比较。主要结局是严重新生儿发病率和死亡率的综合标准，包括围产期死亡、分娩期间的创伤事件、5分钟时Apgar评分<4、中度或重度脑病、出生后24小时内惊厥、3级或4级脑室内出血、2级或3级坏死性小肠结肠炎。
我们纳入了212例患者：引产组64例，自然分娩组136例。引产组45.3%的患者经阴道分娩，自然分娩组为86%。两组的新生儿发病率和死亡率相似：引产组为4.7%，自然分娩组为5.2%，p = 0.889，调整后比值比 = 1.5（0.28 - 8.28）。
近一半接受引产的患者经阴道分娩。分娩发动方式似乎对早产臀位胎儿的严重新生儿发病率和死亡率没有影响。在这种情况下，引产可能是患者的一种选择。
