Jain L, Ferre C, Vidyasagar D
Department of Pediatrics, University of Illinois, Chicago, USA.
J Matern Fetal Med. 1998 Jan-Feb;7(1):28-31. doi: 10.1002/(SICI)1520-6661(199801/02)7:1<28::AID-MFM7>3.0.CO;2-T.
We evaluated the impact of cesarean section (CS) delivery on the outcome of breech very-low-birth-weight (VLBW) (500-1,499 g) infants. This retrospective study used data from a large perinatal data base with 109,428 consecutive deliveries including 1,564 VLBW infants born between 1982 and 1987. The study infants included 982 (62.8%) vertex and 582 (37.2%) breech presentations. The CS rate was higher for the breech group than for the vertex group (72.5% breech, 34.3% vertex, OR 5.1, 95% CI 4.0, 6.4). Breech infants delivered by CS were twice as likely to survive until discharge than those delivered vaginally (breech CS 71.7%, breech vaginal 36.5%, P < .0001). The increased survival with CS for breech presentation (mainly due to fewer deaths on day 1) was not seen with vertex presentation. The CS survival advantage for breech infants was seen in all 250g birth weight subgroups. However, breech VLBW infants delivered by CS had a mean birth weight 233 g more and gestational age 2.1 weeks more than those delivered vaginally. Further, breech infants delivered by CS were more likely to be intubated at birth than vaginally delivered breech infants (OR 4.2, 95% CI 2.0, 5.9). Central nervous system morbidity as measured by the occurrence of seizures and intraventricular hemorrhage was comparable for CS and vaginal infants. Cesarean birth of breech VLBW infants is associated with improved survival. However, breech CS infants were bigger, more mature, and more likely to be intubated at birth than vaginally delivered infants, indicating the presence of a strong selection bias. A prospective randomized trial is needed to evaluate the ideal delivery route for breech VLBW infants.
我们评估了剖宫产对臀位极低出生体重（VLBW，500 - 1499克）婴儿结局的影响。这项回顾性研究使用了来自一个大型围产期数据库的数据，该数据库包含109428例连续分娩病例，其中包括1982年至1987年间出生的1564例VLBW婴儿。研究对象包括982例（62.8%）头位和582例（37.2%）臀位婴儿。臀位组的剖宫产率高于头位组（臀位组72.5%，头位组34.3%，比值比5.1，95%可信区间4.0, 6.4）。剖宫产分娩的臀位婴儿存活至出院的可能性是经阴道分娩者的两倍（臀位剖宫产71.7%，臀位经阴道分娩36.5%，P <.0001）。头位分娩时未观察到剖宫产使存活率增加（主要是由于第1天死亡人数减少）。在所有250克出生体重亚组中均观察到剖宫产对臀位婴儿存活的优势。然而，剖宫产分娩的臀位VLBW婴儿的平均出生体重比经阴道分娩者重233克，孕周多2.1周。此外，剖宫产分娩的臀位婴儿出生时比经阴道分娩的臀位婴儿更有可能需要插管（比值比4.2，95%可信区间2.0, 5.9）。以癫痫发作和脑室内出血发生率衡量的中枢神经系统发病率在剖宫产和经阴道分娩的婴儿中相当。剖宫产臀位VLBW婴儿与存活率提高相关。然而，剖宫产的臀位婴儿比经阴道分娩的婴儿更大、更成熟，且出生时更有可能需要插管，这表明存在强烈的选择偏倚。需要进行一项前瞻性随机试验来评估臀位VLBW婴儿的理想分娩途径。
