Sánchez-Romero Javier, Gallego-Pozuelo Rosa María, Ortuño-Hernández Cristina, Martínez-Zarco Ana, Barroso-Linares Rocío, Araico-Rodríguez Fernando, Blanco-Carnero José Eliseo, Nieto-Díaz Aníbal, de Paco-Matallana Catalina
Maternal-Fetal Unit, Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' Clinic University Hospital, 30120 Murcia, Spain.
Department of Obstetrics, Gynecology, Pediatrics and Surgery, School of Medicine, University of Murcia, 30120 Murcia, Spain.
J Clin Med. 2025 Oct 11;14(20):7179. doi: 10.3390/jcm14207179.
: To evaluate the role of breech progression angle (BPA), a novel transperineal ultrasound parameter, as a predictor of external cephalic version (ECV) success, and to compare BPA between breech and transverse lie presentations. : This prospective exploratory study was nested within a randomized clinical trial (NCT06449430) at Virgen de la Arrixaca University Hospital, Murcia, Spain. Eligible participants were pregnant women ≥18 years with a singleton fetus in non-cephalic presentation at term, without contraindications to vaginal birth. BPA was measured transperineally following standardized methodology prior to ECV, performed under either spinal analgesia or propofol sedation. Logistic regression models adjusted for maternal and obstetric variables assessed the association between BPA and ECV success. Receiver operating characteristic (ROC) curves were generated to evaluate predictive accuracy. : A total of 117 women were included: 100 with breech and 17 with transverse lie presentations. Median BPA was significantly higher in breech compared with transverse lie (87.2° vs. 70.2°, < 0.001). In the overall cohort, BPA was not significantly associated with ECV success (OR 0.97, 95% CI 0.94-1.00; = 0.068). However, in breech presentations, BPA was independently associated with ECV success (adjusted OR 0.95, 95% CI 0.91-0.99; = 0.015). The area under the ROC curve for BPA predicting ECV success in breech cases was 0.64 (95% CI 0.53-0.73). Predictive accuracy was poor for transverse lie (AUC 0.27, 95% CI 0.08-0.56). : BPA measured by transperineal ultrasound does not provide clinically useful information for predicting the success of external cephalic version, either in breech or transverse lie.
评估一种新的经会阴超声参数——臀位进展角度（BPA）作为外倒转术（ECV）成功预测指标的作用，并比较臀位和横位时的BPA。：这项前瞻性探索性研究嵌套于西班牙穆尔西亚阿利克斯卡圣母大学医院的一项随机临床试验（NCT06449430）中。符合条件的参与者为年龄≥18岁、单胎足月非头位且无阴道分娩禁忌证的孕妇。在ECV前，按照标准化方法经会阴测量BPA，ECV在脊髓镇痛或丙泊酚镇静下进行。对孕产妇和产科变量进行调整的逻辑回归模型评估了BPA与ECV成功之间的关联。生成受试者工作特征（ROC）曲线以评估预测准确性。：共纳入117名女性：100名臀位和17名横位。臀位的BPA中位数显著高于横位（87.2°对70.2°，<0.001）。在整个队列中，BPA与ECV成功无显著关联（OR 0.97，95%CI 0.94 - 1.00； = 0.068）。然而，在臀位中，BPA与ECV成功独立相关（调整后OR 0.95，95%CI 0.91 - 0.99； = 0.015）。BPA预测臀位病例中ECV成功的ROC曲线下面积为0.64（95%CI 0.53 - 0.73）。横位的预测准确性较差（AUC 0.27，95%CI 0.08 - 0.56）。：经会阴超声测量的BPA在预测臀位或横位外倒转术成功方面未提供临床有用信息。
