Long Fang, Yan Keqing, Guo Dongxing, Zhaxi Duoji, Xu Xiaoguang, Sun Zhigang, Xiao Zhen
Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Obstetrics and Gynecology, People's Hospital of Naqu, Tibet, China.
Front Med (Lausanne). 2023 Apr 17;10:1048628. doi: 10.3389/fmed.2023.1048628. eCollection 2023.
In high altitude areas, like Tibet, most fetuses in breech presentation at term are delivered vaginally owing to a variety of reasons, but this has not been published.
This study aimed to provide references and evidence for the delivery of breach presentation term fetuses in high altitude areas, through comparing and analyzing the data of full-term singleton fetuses with breech or cephalic presentation in Naqu People's Hospital, Tibet.
We retrospectively analyzed the clinical data of 451 breech presentation fetuses mentioned above over a period of 5 years (2016-2020). A total of 526 cephalic presentation fetuses' data within 3 months (1 June to 1 September 2020) of the same period were collected too. Statistics were compared and assembled on fetal mortality, Apgar scores, and severe neonatal complications for both planned cesarean section (CS) and vaginal delivery. In addition, we also analyzed the types of breech presentation, the second stage of labor, and damage to the maternal perineum during vaginal delivery.
Among the 451 cases of breech presentation fetuses, 22 cases (4.9%) elected for CS and 429 cases (95.1%) elected for vaginal delivery. Of the women who chose vaginal trial labor, 17 cases underwent emergency CSs. The perinatal and neonatal mortality rate was 4.2% in the planned vaginal delivery group and the incidence of severe neonatal complications was 11.7% in the transvaginal group, no deaths were detected in the CS group. Among the 526 cephalic control groups with planned vaginal delivery, the perinatal and neonatal mortality was 1.5% ( = 0.012), and the incidence of severe neonatal complications was 1.9%. Among vaginal breech deliveries, most of them were complete breech presentation (61.17%). Among the 364 cases, the proportion of intact perinea was 45.1%, and first degree lacerations accounted for 40.7%.
In the Tibetan Plateau region, vaginal delivery was less safe than cephalic presentation fetuses for full-term breech presentation fetuses delivered in the lithotomy position. However, if dystocia or fetal distress can be identified in time and then encouraged to convert to cesarean, its safety will be greatly improved.
在西藏等高海拔地区，由于多种原因，大多数足月臀位胎儿经阴道分娩，但尚未见相关报道。
通过对西藏那曲地区人民医院足月单胎臀位和头位胎儿的数据进行比较分析，为高海拔地区足月臀位胎儿的分娩提供参考依据和证据。
回顾性分析上述451例臀位胎儿5年（2016 - 2020年）间的临床资料。同时收集同期3个月内（2020年6月1日至9月1日）526例头位胎儿的数据。对计划剖宫产（CS）和阴道分娩的胎儿死亡率、阿氏评分及严重新生儿并发症进行统计比较和汇总。此外，还分析了臀位类型、第二产程及阴道分娩时产妇会阴损伤情况。
451例臀位胎儿中，22例（4.9%）选择剖宫产，429例（95.1%）选择阴道分娩。选择阴道试产的产妇中，17例行急诊剖宫产。计划阴道分娩组围生儿及新生儿死亡率为4.2%，经阴道分娩组严重新生儿并发症发生率为11.7%，剖宫产组未发现死亡病例。526例计划阴道分娩的头位对照组中，围生儿及新生儿死亡率为1.5%（P = 0.012），严重新生儿并发症发生率为1.9%。阴道臀位分娩中，多数为完全臀先露（61.17%）。364例中，会阴完整比例为45.1%，一度裂伤占40.7%。
在青藏高原地区，对于足月臀位胎儿采用截石位经阴道分娩不如头位胎儿安全。然而，如果能及时识别难产或胎儿窘迫并转为剖宫产，其安全性将大大提高。
