Danielian P J, Wang J, Hall M H
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital.
BMJ. 1996 Jun 8;312(7044):1451-3. doi: 10.1136/bmj.312.7044.1451.
To compare the long-term outcome of infants delivered in breech presentation at term by intended mode of delivery.
A population based comparison of outcomes up to school age. Data obtained from maternity, health visitor, and school medical records and handicap register.
Grampian region 1981-90.
1645 infants delivered alive at term after breech presentation.
Handicap, developmental delay, neurological deficit, psychiatric referral.
Elective caesarean section was performed in 590 (35.9%) cases. The remainder (1055; 64.1%) were intended vaginal deliveries. Handicap or other health problem was recorded in 269 (19.4%) of 1387 infants for whom records were available. Proportions of elective caesarean sections and intended vaginal deliveries in this group were 37.2% (100 cases) and 62.8% (169) respectively, almost the same as in the total cohort. There were no significant differences between elective caesarean section and planned vaginal delivery in terms of severe handicap or any other outcome measure. Case records were obtained for 23 of 27 infants with severe handicap. 11 (47.8%) were delivered by elective caesarean section. Of these, three had undiagnosed congenital abnormalities and seven were unexplained. Of the 12 (52.2%) planned vaginal deliveries, in only one was handicap possibly attributable to delivery and four cases were unavoidable even if elective caesarean section had been planned.
In selected cases of breech presentation at term planned vaginal delivery with caesarean section if necessary remains as safe as elective caesarean section in terms of long term handicap. It was not possible to determine whether particular babies would have fared better had they been delivered by elective caesarean section.
比较足月臀位分娩时预期分娩方式的长期结局。
一项基于人群的学龄期前结局比较研究。数据来源于产妇、健康访视员、学校医疗记录和残疾登记册。
1981 - 1990年格兰扁地区。
1645例足月臀位分娩后存活的婴儿。
残疾、发育迟缓、神经功能缺损、精神科转诊。
590例（35.9%）进行了选择性剖宫产。其余1055例（64.1%）为预期经阴道分娩。在有记录的1387例婴儿中，269例（19.4%）记录有残疾或其他健康问题。该组中选择性剖宫产和预期经阴道分娩的比例分别为37.2%（100例）和62.8%（169例），与总队列几乎相同。在严重残疾或任何其他结局指标方面，选择性剖宫产和计划经阴道分娩之间无显著差异。27例严重残疾婴儿中有23例获得了病例记录。11例（47.8%）通过选择性剖宫产分娩。其中，3例有未诊断出的先天性异常，7例原因不明。在12例（52.2%）计划经阴道分娩的婴儿中，只有1例残疾可能归因于分娩，即使计划进行选择性剖宫产，4例情况也不可避免。
在足月臀位分娩的特定病例中，必要时计划经阴道分娩并适时剖宫产在长期残疾方面与选择性剖宫产一样安全。无法确定如果某些婴儿通过选择性剖宫产分娩，情况是否会更好。
