Department of Obstetrics and Gynecology, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland.
Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Arch Gynecol Obstet. 2023 Oct;308(4):1139-1150. doi: 10.1007/s00404-022-06772-1. Epub 2022 Sep 8.
Previous studies have examined the optimal mode of breech delivery extensively, but there is a scarcity of publications focusing on the birth injuries of neonates born in breech presentation. This study aimed to examine birth injury in breech deliveries.
In this retrospective register-based nationwide cohort study, data on birth injuries in vaginal breech deliveries with singleton live births were compared to cesarean section with breech presentation and cephalic vaginal delivery between 2004 and 2017 in Finland. The data were retrieved from the National Medical Birth Register. Primary outcome variables were severe and mild birth injury. Incidences of birth injuries in different gestational ages and birthweights were calculated in different modes of delivery. Crude odds ratios of risk factors for severe birth injury were analyzed.
In vaginal breech delivery (n = 4344), there were 0.8% of neonates with severe birth injury and 1.5% of neonates with mild birth injury compared to 0.06% and 0.2% in breech cesarean section (n = 16,979) and 0.3% and 1.9% in cephalic vaginal delivery (n = 629,182). Brachial plexus palsy was the most common type of injury in vaginal breech delivery. Increasing gestational age and birthweight had a stronger effect on the risk for injury among cephalic vaginal deliveries than among vaginal breech deliveries.
Birth injuries were rare in vaginal breech deliveries. The incidence of severe birth injury was two times higher in vaginal breech delivery compared to cephalic vaginal delivery. Brachial plexus palsy was the most common type of injury in vaginal breech delivery.
先前的研究已经广泛探讨了臀位分娩的最佳模式，但针对臀位分娩新生儿出生损伤的出版物却很少。本研究旨在探讨臀位分娩中的分娩损伤。
在这项回顾性基于注册的全国性队列研究中，比较了 2004 年至 2017 年期间阴道臀位分娩伴单活胎与剖宫产伴臀位和头位阴道分娩的新生儿出生损伤数据。数据从国家医疗出生登记处获取。主要结局变量为严重和轻度分娩损伤。不同分娩方式下不同胎龄和出生体重的分娩损伤发生率进行了计算。分析了严重分娩损伤的危险因素的粗比值比。
在阴道臀位分娩（n=4344）中，严重分娩损伤的新生儿占 0.8%，轻度分娩损伤的新生儿占 1.5%，而剖宫产臀位（n=16979）中分别为 0.06%和 0.2%，头位阴道分娩（n=629182）中分别为 0.3%和 1.9%。臂丛神经损伤是阴道臀位分娩中最常见的损伤类型。胎龄和出生体重的增加对头位阴道分娩的损伤风险影响大于阴道臀位分娩。
阴道臀位分娩中的分娩损伤很少见。阴道臀位分娩的严重分娩损伤发生率是头位阴道分娩的两倍。臂丛神经损伤是阴道臀位分娩中最常见的损伤类型。
