Leiberman J R, Fraser D, Mazor M, Chaim W, Karplus M, Katz M, Glezerman M
Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Eur J Obstet Gynecol Reprod Biol. 1995 Aug;61(2):111-5. doi: 10.1016/0301-2115(95)02115-n.
To examine pregnancy outcome in nulliparous women with single term breech presentation.
Two departments of Obstetrics and Gynecology at the same hospital used different approaches to deliver nulliparous women with singleton breech presentation at term. One department (A) delivered by trial of labor and the other (B) delivered by elective cesarean section. Prospectively and blinded to obstetric condition, parturients were assigned to either department in a systematic alternate fashion. The study period covered 8 years (1985-1992). The pregnancy outcome parameters examined were: Apgar score, intra- and post-partum death and maternal and neonatal morbidity. Neonatal morbidity was classified in three major categories: non-neurological trauma, neurological signs and respiratory problems.
The study included 264 women of whom 135 delivered in department A and 129 in department B. Department A had 35 vaginal and 100 cesarean births and department B 10 vaginal and 119 cesarean births. There was no intra-partum death and the only post-partum death occurred among vaginal deliveries. The Apgar score was significantly worse at 1 and 5 min in vaginally delivered babies of department B. Neonatal morbidity was significantly more frequent after vaginal births (P < 0.01). Maternal morbidity was significantly higher following cesarean sections (P < 0.01). Babies of vaginal deliveries had significantly higher non-neurological trauma (P < 0.01) and pathological neurological signs (P < 0.01) than those delivered by the abdominal route.
The level of risk for mother and child in the nulliparous with term singleton breech, suggests cesarean section as the preferred route of delivery.
研究初产妇单胎足月臀先露的妊娠结局。
同一家医院的两个妇产科采用不同方法为足月单胎臀先露的初产妇接生。一个科室（A）采用试产，另一个科室（B）采用选择性剖宫产。前瞻性且不了解产科情况，产妇以系统交替的方式被分配到任一科室。研究期为8年（1985 - 1992年）。所检查的妊娠结局参数包括：阿氏评分、产时及产后死亡以及母婴发病率。新生儿发病率分为三大类：非神经创伤、神经体征和呼吸问题。
该研究纳入264名女性，其中135名在A科室分娩，129名在B科室分娩。A科室有35例阴道分娩和100例剖宫产，B科室有10例阴道分娩和119例剖宫产。产时无死亡，仅产后死亡发生在阴道分娩者中。B科室阴道分娩婴儿在1分钟和5分钟时的阿氏评分明显更差。阴道分娩后新生儿发病率明显更高（P < 0.01）。剖宫产术后产妇发病率明显更高（P < 0.01）。阴道分娩的婴儿比经腹分娩的婴儿有明显更高的非神经创伤（P < 0.01）和病理性神经体征（P < 0.01）。
初产妇单胎足月臀先露时母婴的风险水平表明剖宫产是首选的分娩方式。
