Berthommier Laura, Planche Lucie, Ducarme Guillaume
Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France.
Clinical Research Center, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France.
J Clin Med. 2022 Nov 30;11(23):7118. doi: 10.3390/jcm11237118.
Vaginal delivery in women with a breech presentation is part of common practice in France despite much debate, and the induction of labor (IOL) with a fetus in a breech presentation at term remains uncommon. Little is known about the effectiveness of cervical ripening and its neonatal and maternal safety in these women. We present a retrospective study of 362 women who gave birth to a live singleton fetus in a breech presentation at term. The objective was to compare severe maternal and neonatal morbidity according to the planned mode of labor (spontaneous labor or the induction of labor (IOL) with a favorable cervix, cervical ripening, or elective cesarean delivery) and, specifically, to compare cervical ripening to the other modes of labor. The rate of severe neonatal morbidity was 3.0% and was significantly higher after the IOL compared to elective cesarean delivery ( = 0.02), and the severe maternal morbidity rates were similar. Multivariable logistic regression analysis found no significant association between cervical ripening and either composite severe neonatal (adjusted odds ratio [aOR] 2.80, 95% confidence interval [CI] 0.10-43.6) or maternal morbidity (aOR 1.29, 95% CI 0.05-11.5). Our results support a policy of offering cervical ripening to the appropriately selected candidates with a singleton fetus in a breech presentation at term without increasing the incidence of severe maternal and neonatal morbidity.
尽管存在诸多争议，但臀位分娩在法国仍是常见的分娩方式，而足月臀位胎儿的引产（IOL）仍不常见。对于这些女性宫颈成熟的有效性及其新生儿和产妇安全性，人们知之甚少。我们对362例足月分娩单胎活产臀位胎儿的女性进行了一项回顾性研究。目的是根据计划的分娩方式（自然分娩或宫颈条件良好时的引产（IOL）、宫颈成熟或择期剖宫产）比较严重的孕产妇和新生儿发病率，特别是将宫颈成熟与其他分娩方式进行比较。严重新生儿发病率为3.0%，与择期剖宫产相比，引产（IOL）后的发病率显著更高（P = 0.02），严重孕产妇发病率相似。多变量逻辑回归分析发现，宫颈成熟与复合严重新生儿发病率（调整优势比[aOR] 2.80，95%置信区间[CI] 0.10 - 43.6）或孕产妇发病率（aOR 1.29，95% CI 0.05 - 11.5）之间均无显著关联。我们的结果支持一项政策，即向适当选择的足月单胎臀位胎儿的孕妇提供宫颈成熟，而不增加严重孕产妇和新生儿发病率。
