Laros R K, Flanagan T A, Kilpatrick S J
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, USA.
Am J Obstet Gynecol. 1995 Jun;172(6):1916-23; discussion 1923-5. doi: 10.1016/0002-9378(95)91432-3.
The results of a program of external version and selective trial of labor for term breech presentation are reviewed. This is a follow-up to our 1987 report describing management of singleton, term breech presentations and expands our 16-year experience to 1180 cases.
All term breech presentations cared for in 1985 through 1992 are reviewed and outcome contrasted with those predicted in our earlier report. During these 8 years a trial of external version was offered if a breech presentation was identified after 36 completed weeks' gestation and before active labor. The criteria for allowing a trial of labor are detailed.
Four hundred sixty-four breech presentations were identified for review. Three hundred eighty-two (82%) were diagnosed before active labor. Of these, 344 (90%) underwent an attempt at external version, of which 174 (51%) were successful. The 290 breech presentations where version either was not attempted or was unsuccessful were stratified into three groups: cesarean section without labor (147), trial of labor with cesarean section (90), and trial of labor with vaginal delivery (53). The 174 cases where version was successful were stratified into two additional groups on the basis of the eventual route of delivery. Careful review of maternal and fetal variables indicates that a trial of labor in selected patients resulted in vaginal delivery in only 37% but was achieved without an increase in fetal or maternal mortality or morbidity. Surprisingly, 54 of the 174 cases where version was successful were ultimately delivered by cesarean section. This 31% rate of cesarean delivery is significantly higher than the 15% rate observed for all cases of term, singleton vertex presentation. A higher prevalence of cases complicated by failed progress in labor and failed induction contributed to the excess.
External version is successful in 51% of cases of term breech presentation. With careful selection, cases where version has failed can be allowed to labor and be delivered vaginally. The incidence of cesarean section (31%) for those cases where version had been successful was surprisingly high, largely because of an increase in labor abnormalities and failed labor inductions.
回顾一项针对足月臀位的外倒转术及选择性试产计划的结果。这是对我们1987年关于单胎足月臀位管理报告的后续研究，并将我们16年的经验扩展至1180例病例。
对1985年至1992年期间所有接受治疗的足月臀位病例进行回顾，并将结果与我们早期报告中预测的结果进行对比。在这8年中，如果在妊娠满36周后且在活跃产程开始前确诊为臀位，则提供外倒转术尝试。详细说明了允许试产的标准。
共确定464例臀位病例进行回顾。382例（82%）在活跃产程开始前被诊断。其中，344例（90%）尝试了外倒转术，其中174例（51%）成功。290例未尝试外倒转术或外倒转术失败的臀位病例被分为三组：未临产剖宫产（147例）、试产加剖宫产（90例）和试产加阴道分娩（53例）。174例外倒转术成功的病例根据最终分娩途径又分为另外两组。对母体和胎儿变量的仔细回顾表明，在选定患者中进行试产仅37%导致阴道分娩，但在不增加胎儿或母体死亡率或发病率的情况下实现。令人惊讶的是，174例外倒转术成功的病例中有54例最终通过剖宫产分娩。这种31%的剖宫产率显著高于所有足月单胎头位病例观察到的15%的剖宫产率。产程进展失败和引产失败的病例患病率较高导致了这一超额情况。
外倒转术在51%的足月臀位病例中成功。经过仔细选择，外倒转术失败的病例可允许试产并经阴道分娩。外倒转术成功的病例剖宫产率（31%）出奇地高，主要是因为产程异常和引产失败增加。
