Gifford D S, Keeler E, Kahn K L
RAND, Santa Monica, California, USA.
Obstet Gynecol. 1995 Jun;85(6):930-6. doi: 10.1016/0029-7844(95)00044-R.
To describe currently accepted methods for managing the term breech pregnancy, and to predict the delivery outcomes and costs of each method.
Literature review was used to derive four options for the peripartum management of the term breech pregnancy. Using decision-analysis techniques, we calculated the predicted delivery outcomes and costs associated with each option.
Applying external cephalic version to all term breech pregnancies without contraindications to labor or version, and allowing a trial of labor for eligible women who fail version, results in a 25% cesarean rate, at a cost of $8071 per case. Delivering unsuccessful versions by scheduled cesarean results in a 32% cesarean rate, at a cost of $8276 per case. In contrast, a strategy not using external version but allowing a trial of labor for those mothers who meet eligibility criteria results in a 63% cesarean rate, at a cost of $8755 per case. Routinely scheduling a cesarean when a breech is identified at term results in an 89% cesarean rate, at a cost of $9544 per case.
Although the liberal use of vaginal delivery for term breech pregnancies has been suggested as one way of lowering the cesarean rate, the addition of routine external cephalic version to the management strategy will result in more vaginal deliveries and lower costs than strategies that allow vaginal delivery but do not include an attempted cephalic version. Routine cesarean without attempted external cephalic version results in excessive operative deliveries.
描述目前公认的足月臀位妊娠管理方法，并预测每种方法的分娩结局和成本。
通过文献综述得出足月臀位妊娠围产期管理的四种选择。使用决策分析技术，我们计算了与每种选择相关的预测分娩结局和成本。
对所有无引产或外倒转术禁忌证的足月臀位妊娠应用外倒转术，并允许对倒转术失败的符合条件的妇女进行试产，剖宫产率为25%，每例成本为8071美元。对倒转术不成功者行择期剖宫产，剖宫产率为32%，每例成本为8276美元。相比之下，不采用外倒转术但允许符合条件的母亲进行试产的策略，剖宫产率为63%，每例成本为8755美元。足月时确诊为臀位即常规安排剖宫产，剖宫产率为89%，每例成本为9544美元。
尽管有人建议放宽足月臀位妊娠的阴道分娩以降低剖宫产率，但与允许阴道分娩但不包括外倒转术尝试的策略相比，在管理策略中增加常规外倒转术将导致更多的阴道分娩和更低的成本。未尝试外倒转术而常规剖宫产会导致手术分娩过多。
