Engel Offra, Arnon Shmuel, Shechter Maor Gil, Schreiber Hanoch, Piura Ettie, Markovitch Ofer
Obstetrical & Gynecological Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Children (Basel). 2023 Feb 10;10(2):354. doi: 10.3390/children10020354.
External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. Following ECV, fetal well-being is assessed via a non-stress test (NST). An alternative option to identify signs of fetal compromise is via the Doppler indices of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). Inclusion criteria were an uncomplicated pregnancy with breech presentation at term. Doppler velocimetry of the UA, MCA and DV were performed up to 1 h before and up to 2 h after ECV. The study included 56 patients who underwent elective ECV with a success rate of 75%. After ECV, the UA S/D ratio, UA pulsatility index (PI) and UA resistance index (RI) were increased compared to before the ECV ( = 0.021, = 0.042, and = 0.022, respectively). There were no differences in the Doppler MCA and DV before or after ECV. All patients were discharged after the procedure. ECV is associated with changes in the UA Doppler indices that might reflect interference in placental perfusion. These changes are probably short-term and have no detrimental effects on the outcomes of uncomplicated pregnancies. ECV is safe; yet it is a stimulus or stress that can affect placental circulation. Therefore, careful case selection for ECV is important.
外倒转术（ECV）是足月臀位的一种经济有效且安全的治疗选择。外倒转术后，通过无应激试验（NST）评估胎儿健康状况。另一种识别胎儿窘迫迹象的方法是通过脐动脉（UA）、大脑中动脉（MCA）和静脉导管（DV）的多普勒指数。纳入标准为足月臀位的无并发症妊娠。在ECV前1小时内及ECV后2小时内进行UA、MCA和DV的多普勒测速。该研究纳入了56例行择期ECV的患者，成功率为75%。ECV后，与ECV前相比，UA的S/D比值、UA搏动指数（PI）和UA阻力指数（RI）均升高（分别为P = 0.021、P = 0.042和P = 0.022）。ECV前后MCA和DV的多普勒检查无差异。所有患者术后均出院。ECV与UA多普勒指数的变化有关，这可能反映了胎盘灌注受到干扰。这些变化可能是短期的，对无并发症妊娠的结局没有不利影响。ECV是安全的；但它是一种可影响胎盘循环的刺激或应激。因此，仔细选择ECV的病例很重要。
