Bogner Gerhard, Schuller Johanna, Gargitter Carina, Dölzlmüller Eva, Fischer Thorsten, Fazelnia Claudius
Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.
Paracelsus Medical University, Salzburg, Austria.
Acta Obstet Gynecol Scand. 2025 Jun;104(6):1153-1161. doi: 10.1111/aogs.15078. Epub 2025 Apr 1.
Vaginal delivery in cases of breech presentation is considered potentially stressful for the newborn. The maternal upright position may represent a more physiological approach to facilitating birth. We compare the safety and efficacy of two maternal positions in vaginal breech delivery.
A prospective, single-center, observational cohort study from October 2006 to January 2021 in a high-level obstetric center, in Salzburg, Austria. Vaginal breech deliveries in maternal all-fours position (n = 140) were compared with those in assisted supine position (n = 92). The primary outcome measures for neonatal morbidity included Apgar scores, pH levels, and the rate of transfer to the Neonatal Intensive Care Unit (NICU) postdelivery.
In the all-fours position, 51.4% (n = 72) of deliveries occurred without obstetric intervention. The second stage of labor was significantly shorter in the supine position (39.5 min [95% CI 28-47] versus all fours position 52 min [95% CI 42-63], p = 0.042). Umbilical artery pH levels did not differ significantly (7.21 [95% CI 7.19-7.23] versus 7.19 [95% CI 7.17-7.21] vs. p = 0.06). Nor did the APGAR scores at 5 and 10 min below eight (p = 0.697; p = 0.760). Maternal and neonatal morbidity also did not significantly differ. Transfer of neonates to NICU n = 12 (13%) versus n = 11 (7.9%), p = 0.097, transfer birth-related n = 6 (6.5%) versus n = 8 (5.7%), p = 0.803. The number of postpartum umbilical artery pH < 7.10 were n = 9 (9.8%) versus n = 28 (20%), p = 0.065. There was one reported neonatal death due to intracerebral hemorrhage in the supine position group.
Our results indicate that vaginal breech delivery in the all-fours position seems to be comparable to supine position regarding neonatal safety. Additionally, the all-fours position shows potential for emergency management for unplanned breech deliveries by inexperienced attendants.
臀位分娩时，经阴道分娩对新生儿来说可能有潜在压力。产妇直立位可能是促进分娩的更符合生理的方式。我们比较了两种产妇体位在阴道臀位分娩中的安全性和有效性。
2006年10月至2021年1月在奥地利萨尔茨堡一家高级产科中心进行的一项前瞻性、单中心观察性队列研究。将产妇膝胸卧位阴道臀位分娩（n = 140）与辅助仰卧位阴道臀位分娩（n = 92）进行比较。新生儿发病率的主要结局指标包括阿氏评分、pH值水平以及产后转入新生儿重症监护病房（NICU）的比率。
在膝胸卧位分娩中，51.4%（n = 72）的分娩未进行产科干预。仰卧位第二产程明显更短（39.5分钟[95%置信区间28 - 47]，而膝胸卧位为52分钟[95%置信区间42 - 63]，p = 0.042）。脐动脉pH值水平无显著差异（7.21[95%置信区间7.19 - 7.23]与7.19[95%置信区间7.17 - 7.21]，p = 0.06）。5分钟和10分钟时阿氏评分低于8分的情况也无显著差异（p = 0.697；p = 0.760）。产妇和新生儿发病率也无显著差异。转入NICU的新生儿，膝胸卧位组n = 12（13%），仰卧位组n = 11（7.9%），p = 0.097；与分娩相关的转入情况，膝胸卧位组n = 6（6.5%），仰卧位组n = 8（5.7%），p = 0.803。产后脐动脉pH值<7.10的数量，膝胸卧位组n = 9（9.8%），仰卧位组n = 28（20%），p = 0.065。仰卧位组有1例因脑出血报告的新生儿死亡。
我们的结果表明，就新生儿安全性而言，膝胸卧位阴道臀位分娩似乎与仰卧位相当。此外，膝胸卧位对于经验不足的医护人员处理计划外臀位分娩的紧急情况有潜在优势。
