Abstract：
OBJECTIVE: Uterine anomalies (UA) occur in up to 6.7% of women. Breech is eight times more likely to occur with UA which may not be diagnosed prior to pregnancy and may only be found in the third trimester with breech. The objective of the study is to assess the prevalence of both already known and newly sonographically diagnosed UA in breech from 36 weeks of gestation and its impact on external cephalic version (ECV), delivery options and perinatal outcomes.
METHODS: We recruited 469 women with breech at 36 weeks of gestation over a 2-year period at the Charité University Hospital, Berlin. Ultrasound examination was performed to rule out UA. Patients with known and newly \'de novo\' diagnosed anomalies were identified and delivery options and perinatal outcomes analyzed.
RESULTS: The \'de novo\' diagnosis of UA at 36-37 weeks of pregnancy with breech was found to be significantly higher compared to the diagnosis prior to pregnancy with 4.5% vs 1.5% (p < 0.001 and odds ratio 4 with 95% confidence interval 2.12-7.69). Anomalies found included 53.6% bicornis unicollis, 39.3% subseptus, 3.6% unicornis and 3.6% didelphys. A trial of vaginal breech delivery was successful in 55.5% of cases when attempted. There were no successful ECVs.
CONCLUSIONS: Breech is a marker for uterine malformation. Diagnosis of UA with breech can be up to four times improved with focused ultrasound screening in pregnancy even from 36 weeks of gestation prior to ECV to identify missed anomalies. Timely diagnosis aids antenatal care and delivery planning. Importantly, definitive diagnosis and treatment can be planned postpartum to improve outcomes in future pregnancies. ECV plays a limited role in selected cases.
METHODS: We recruited 469 women with breech at 36 weeks of gestation over a 2-year period at the Charité University Hospital, Berlin. Ultrasound examination was performed to rule out UA. Patients with known and newly \'de novo\' diagnosed anomalies were identified and delivery options and perinatal outcomes analyzed.
RESULTS: The \'de novo\' diagnosis of UA at 36-37 weeks of pregnancy with breech was found to be significantly higher compared to the diagnosis prior to pregnancy with 4.5% vs 1.5% (p < 0.001 and odds ratio 4 with 95% confidence interval 2.12-7.69). Anomalies found included 53.6% bicornis unicollis, 39.3% subseptus, 3.6% unicornis and 3.6% didelphys. A trial of vaginal breech delivery was successful in 55.5% of cases when attempted. There were no successful ECVs.
CONCLUSIONS: Breech is a marker for uterine malformation. Diagnosis of UA with breech can be up to four times improved with focused ultrasound screening in pregnancy even from 36 weeks of gestation prior to ECV to identify missed anomalies. Timely diagnosis aids antenatal care and delivery planning. Importantly, definitive diagnosis and treatment can be planned postpartum to improve outcomes in future pregnancies. ECV plays a limited role in selected cases.
摘要：
目的：子宫异常（UA）发生率高达6.7％。臀位发生UA的可能性要高出八倍，在怀孕前可能无法诊断，并且可能仅在臀位的妊娠晚期发现。该研究的目的是评估妊娠36周以来已知和新超声诊断的臀位UA的患病率及其对外头型（ECV）的影响，分娩选择和围产期结局。
方法：我们在Charité大学医院招募了469名妊娠36周的臀位女性，柏林。进行超声检查以排除UA。确定了已知和新诊断出异常的患者，并分析了分娩选择和围产期结局。
结果：发现与妊娠前的诊断相比，在妊娠36-37周时对UA的“从头”诊断明显更高，分别为4.5％和1.5％（p<0.001和比值比4，95％置信区间为2.12-7.69）。发现的异常包括53.6%的双目独科利斯，39.3%subseptus,3.6%独角兽和3.6%didelphys。尝试进行阴道臀位分娩的试验在55.5％的病例中成功。没有成功的ECV。
结论：臀位是子宫畸形的标志。即使在ECV之前妊娠36周以确定遗漏的异常，妊娠中的聚焦超声筛查也可以使臀位UA的诊断提高四倍。及时诊断有助于产前护理和分娩计划。重要的是,产后可计划明确的诊断和治疗,以改善未来妊娠结局.ECV在选定病例中的作用有限。
方法：我们在Charité大学医院招募了469名妊娠36周的臀位女性，柏林。进行超声检查以排除UA。确定了已知和新诊断出异常的患者，并分析了分娩选择和围产期结局。
结果：发现与妊娠前的诊断相比，在妊娠36-37周时对UA的“从头”诊断明显更高，分别为4.5％和1.5％（p<0.001和比值比4，95％置信区间为2.12-7.69）。发现的异常包括53.6%的双目独科利斯，39.3%subseptus,3.6%独角兽和3.6%didelphys。尝试进行阴道臀位分娩的试验在55.5％的病例中成功。没有成功的ECV。
结论：臀位是子宫畸形的标志。即使在ECV之前妊娠36周以确定遗漏的异常，妊娠中的聚焦超声筛查也可以使臀位UA的诊断提高四倍。及时诊断有助于产前护理和分娩计划。重要的是,产后可计划明确的诊断和治疗,以改善未来妊娠结局.ECV在选定病例中的作用有限。
