Koike T, Minakami H, Sasaki M, Sayama M, Tamada T, Sato I
Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan.
Arch Gynecol Obstet. 1996;258(3):119-23. doi: 10.1007/s004040050112.
We retrospectively analyzed 546 consecutive singleton pregnancies with breech presentations that ended at > or = 36 weeks of gestation for the relationship between the intended mode of delivery and fetal outcome. Twelve patients were excluded from the analysis because these infants had major malformations. Of the 534 remaining patients, 124 (23%) were delivered by elective cesarean section. The other 410 women (77%) went into spontaneous labor. Intrapartum emergency cesarean section was required in 112 (27%) of these 410 women; the other 298 (73%) were delivered vaginally. There were 5 poor neonatal outcomes: 3 perinatal deaths and 2 cases of cerebral palsy probably due to intrapartum asphyxia. The risk of poor outcome was thus 1.2% (5/410), in the intended vaginal delivery group vs. no such outcome in the group of 124 patients that had an elective cesarean section. Three of 5 infants with poor outcome were actually born by emergency cesarean section and comparisons of results according to ultimate method of delivery rather than according to intended method of delivery may be misleading and in our case would have been biased against cesarean section.
我们回顾性分析了546例连续的单胎臀位妊娠病例，这些妊娠在妊娠36周及以上结束，以探讨计划分娩方式与胎儿结局之间的关系。12例患者被排除在分析之外，因为这些婴儿有严重畸形。在其余534例患者中，124例（23%）通过择期剖宫产分娩。其他410名妇女（77%）自然临产。这410名妇女中有112例（27%）需要在分娩期行急诊剖宫产；其他298例（73%）经阴道分娩。有5例新生儿结局不良：3例围产儿死亡和2例可能因分娩期窒息导致的脑瘫。因此，计划阴道分娩组不良结局的风险为1.2%（5/410），而124例择期剖宫产患者组无此类结局。5例结局不良的婴儿中有3例实际上是通过急诊剖宫产出生的，根据最终分娩方式而非计划分娩方式进行结果比较可能会产生误导，在我们的案例中会偏向于不利于剖宫产。
