Department of Obstetrics & Gynecology, Jewish General Hospital, McGill University, Pav H, Room 412, 5790 Cote-Des-Neiges Road, Montreal, Quebec H3S 1Y9, Canada.
Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
J Gynecol Obstet Hum Reprod. 2024 Dec;53(10):102827. doi: 10.1016/j.jogoh.2024.102827. Epub 2024 Jul 22.
Over the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses.
This retrospective population-based cohort study utilized data from the United States' Period Linked Birth-Infant Death Public Use Files from 2008 to 2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n = 546,842) and divided into two cohorts: women who had a planned vaginal birth (n = 116,828), and women who had a planned cesarean section (n = 430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes.
It was observed that 26.14 % of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95 % CI 1.16-1.52, admission to NICU,1.23, 1.19-1.27, ventilation support at 〈 6 h of life, 1.47, 1.42-1.52, ventilation support at 〉 6 h of life, 1.19, 1.08-1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06-2.50.
In women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.
在过去的几十年中，剖宫产已被推荐为臀位分娩的最安全分娩方式。本研究的目的是评估计划阴道分娩与计划剖宫产在臀位胎儿中的结局。
本回顾性基于人群的队列研究使用了 2008 年至 2017 年美国时期链接出生-婴儿死亡公共使用文件的数据。确定了所有足月单胎无先天畸形的活产臀位分娩（n = 546842），并分为两个队列：计划阴道分娩的妇女（n = 116828）和计划剖宫产的妇女（n = 430014）。使用多变量逻辑回归模型，根据产妇基线特征进行调整，研究了计划分娩方式与新生儿结局之间的关系。
观察到计划阴道分娩队列中有 26.14%的产妇进行了阴道分娩。在调整后的分析中，臀位分娩计划行阴道分娩与不良新生儿结局风险增加相关，包括婴儿死亡，OR 1.32，95%CI 1.16-1.52，新生儿重症监护病房（NICU）入院，1.23，1.19-1.27，〈6 小时通气支持，1.47，1.42-1.52，〉6 小时通气支持，1.19，1.08-1.31，以及 5 分钟时 Apgar 评分≤3，2.27，2.06-2.50。
在臀位胎儿的产妇中，计划阴道分娩成功率低，且与新生儿发病率和死亡率增加相关。应向产妇仔细告知臀位阴道分娩相关风险以及阴道分娩成功率低的问题。
