Lia Massimiliano, Martin Mireille, Költzsch Elisabeth, Stepan Holger, Dathan-Stumpf Anne
Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany.
Birth. 2024 Sep;51(3):530-540. doi: 10.1111/birt.12808. Epub 2023 Dec 19.
We investigated possible parameters that could predict the need for obstetric maneuvers, the duration of the active second stage of labor (i.e., the duration of active pushing), and short-term neonatal outcome in vaginal breech births.
We performed a retrospective analysis of 268 successful singleton vaginal breech births in women without previous vaginal births from January 2015 to August 2022. Multivariable regression was used to investigate associations between maternal and fetal characteristics (including antepartum magnetic resonance (MR) pelvimetry) with obstetric maneuvers, the duration of active second stage of labor, pH values, and admission to the neonatal unit. Models for the prediction of obstetric maneuvers were built and internally validated.
Obstetric maneuvers were performed in a total of 130 women (48.5%). A total of 32 neonates (11.9%) had to be admitted to the neonatal unit. The intertuberous distance (ITD) (p < 0.001), epidural analgesia (p < 0.001), and birthweight (p = 0.026) were associated with the duration of active second stage of labor. ITD (p = 0.028) and birthweight (p = 0.011) were also independently associated with admission to the neonatal unit, while pH values below 7.10 dropped significantly (p = 0.0034) if ITD was ≥13 cm. Furthermore, ITD (p < 0.001) and biparietal diameter (p = 0.002) were independent predictors for obstetric maneuvers.
ITD is independently associated with the duration of active second stage of labor. Thus, it can predict suboptimal birth mechanics in the last stage of birth, which may lead to the need for obstetric maneuvers, lower arterial pH values, and admission to the neonatal unit. Consequently, MR pelvimetry gives additional information for practitioners and birthing people preferring a vaginal breech birth.
我们研究了可能预测产科操作需求、第二产程活跃期（即有效用力期）时长以及阴道臀位分娩短期新生儿结局的参数。
我们对2015年1月至2022年8月期间268例首次阴道分娩的单胎成功阴道臀位分娩病例进行了回顾性分析。采用多变量回归研究母体和胎儿特征（包括产前磁共振（MR）骨盆测量）与产科操作、第二产程活跃期时长、pH值以及新生儿入住新生儿重症监护病房之间的关联。构建并内部验证了预测产科操作的模型。
共有130名女性（48.5%）接受了产科操作。共有32名新生儿（11.9%）不得不入住新生儿重症监护病房。坐骨结节间径（ITD）（p < 0.001）、硬膜外镇痛（p < 0.001）和出生体重（p = 0.026）与第二产程活跃期时长相关。ITD（p = 0.028）和出生体重（p = 0.011）也与新生儿入住新生儿重症监护病房独立相关，而当ITD≥13 cm时，pH值低于7.10显著下降（p = 0.0034）。此外，ITD（p < 0.001）和双顶径（p = 0.002）是产科操作的独立预测因素。
ITD与第二产程活跃期时长独立相关。因此，它可以预测分娩最后阶段不理想的分娩力学，这可能导致需要进行产科操作、动脉pH值降低以及新生儿入住新生儿重症监护病房。因此，MR骨盆测量为倾向于阴道臀位分娩的从业者和产妇提供了额外信息。
