Aviv Danit, Weintraub Amir, Issakov Gal, Pasternak Yael, Griffin Rachel, Shochat Tzipora, Lopian Miriam, Yekel Yael, Perlman Sharon
Adelson School of Medicine, Ariel University, Ariel, Israel.
Department of Obstetrics and Gynecology, Laniado Medical Center, Divrei Hayim 16, Netanya, Israel.
Arch Gynecol Obstet. 2025 May;311(5):1267-1273. doi: 10.1007/s00404-024-07873-9. Epub 2024 Dec 26.
To determine whether patients undergoing a trial of labor with a breech presentation following a failed attempt of external cephalic version (ECV) are at increased risk of adverse maternal and neonatal outcomes.
This retrospective cohort study was conducted at a single university-affiliated medical center. The study group comprised women with singleton pregnancies at term, categorized into three groups: those who underwent a failed external cephalic version (ECV) and subsequently attempted a trial of breech delivery (Breech-failed-ECV group), those who attempted an assisted vaginal breech delivery without a prior ECV attempt (Breech-no-ECV group), and those with vertex presentation following a successful ECV (Vertex-ECV). The primary outcome measured was the mode of delivery. Secondary outcomes included adverse maternal and neonatal outcomes.
The study group consisted of 229 patients who attempted a vaginal delivery during the study period following a diagnosis of non-cephalic presentation at term. There were 42 women in the Breech failed-ECV group, 102 in the Breech-no-ECV group, and 85 in the Vertex-ECV group. Among patients undergoing a trial of labor with a breech presentation, there were no significant differences in successful vaginal delivery rates between those who had an attempted ECV and those who did not (80.39% vs. 80.95%, p > 0.05), nor in the rate of adverse maternal or neonatal outcomes between the groups. However, the Vertex-ECV were more likely to have a vaginal delivery (91.78 vs 80.56%, p = 0.03) and less likely to experience adverse neonatal outcomes, including meconium-stained amniotic fluid, non-reassuring fetal heart rate (NRFHR), compared to those who underwent labor with a breech presentation (p < 0.05).
A failed external cephalic version does not adversely affect maternal or neonatal outcomes in patients undergoing a trial of labor with a breech presentation and meet the criteria of our study.
确定在外部倒转术（ECV）尝试失败后进行臀位分娩试验的患者，其孕产妇和新生儿不良结局的风险是否增加。
这项回顾性队列研究在一家大学附属医院医疗中心进行。研究组包括足月单胎妊娠的女性，分为三组：外部倒转术（ECV）尝试失败后随后尝试臀位分娩试验的女性（臀位-失败-ECV组），未事先尝试ECV而尝试辅助阴道臀位分娩的女性（臀位-无-ECV组），以及外部倒转术（ECV）成功后为头位的女性（头位-ECV组）。测量的主要结局是分娩方式。次要结局包括孕产妇和新生儿不良结局。
研究组由229名在研究期间诊断为足月非头位后尝试阴道分娩的患者组成。臀位-失败-ECV组有42名女性，臀位-无-ECV组有102名，头位-ECV组有85名。在进行臀位分娩试验的患者中，尝试过ECV的患者与未尝试过ECV的患者在成功阴道分娩率上无显著差异（80.39%对80.95%，p＞0.05），两组间孕产妇或新生儿不良结局发生率也无显著差异。然而，与进行臀位分娩的患者相比，头位-ECV组更有可能阴道分娩（91.78%对80.56%，p = 0.03），且发生不良新生儿结局的可能性更小，包括羊水粪染、胎儿心率异常（NRFHR）（p＜0.05）。
对于进行臀位分娩试验且符合我们研究标准的患者，外部倒转术失败不会对孕产妇或新生儿结局产生不利影响。
