PDF(Pubmed)
Abstract：
Introduction: In 3-6% of pregnancies, foetuses can be expected to be in a breech presentation near term. Consultation concerning further management of the pregnancy, including the option of an external cephalic version (ECV), is recommended by international guidelines (RCOG, ACOG, and DGGG). With regards to an ECV, there need to be two assumptions. Firstly, the procedure is safe, which has been shown adequately. Secondly, a vaginal birth after a successful ECV needs to prove to be non-inferior to the alternative of an elective caesarean section. The aim of this study is to assess the non-inferiority assumption. Methods: Overall, 142 singleton pregnancies were analysed that presented a foetus in a non-cephalic presentation and underwent an ECV near term between 2011 and 2020. The ECV was performed at 36 weeks of gestation for primiparous women and at 37/38 weeks of gestation for multiparous women. To assess neonatal outcome, the following parameters were recorded: arterial and venous umbilical cord blood pH, APGAR scores and admission to the neonatal intensive care unit (NICU). Data were analysed under the assumption that neonatal outcome does not differ between elective caesarean sections with or without an ECV in advance. Results: The success rate of an ECV was 56.3% (80/142). In the case of a successful ECV, there was a 77.5% (62/80) chance for a vaginal delivery. The mean arterial pH for neonates born vaginally after successful ECV was 7.262 (SD 0.089), compared to 7.316 (SD 0.051) for those born via elective caesarean section (p < 0.001). APGAR scores at 1, 5, and 10 min were similar between the groups, with a slightly higher proportion of neonates scoring below the median in the caesarean section group. Specifically, 13.7% (7/51) at 1 min, 15.7% (8/51) at 5 min, and 9.8% (5/51) at 10 min in the caesarean section group were below the median, compared to 4.92% (3/61), 4.92% (3/61), and 3.28% (2/61) in the vaginal birth group. NICU admission rates were 3.28% for vaginal births and 3.92% for elective caesarean sections (p > 0.05). Conclusions: Women with a successful ECV can expect a neonatal birth outcome after a vaginal birth that is non-inferior to an alternative elective caesarean section.
摘要：
简介：在3-6％的怀孕中，胎儿有望在近期内出现臀位。关于怀孕的进一步管理的咨询，包括外部头部版本（ECV）的选项，是国际准则推荐的(RCOG，ACOG,和DGGG）。关于ECV，需要有两个假设。首先,手术是安全的,这一点已经得到了充分的证明。其次,ECV成功后的阴道分娩需要证明不劣于选择性剖腹产.这项研究的目的是评估非劣效性假设。方法：总体，分析了142例单胎妊娠，这些妊娠在2011年至2020年之间出现了无头胎儿，并在近期进行了ECV。ECV在初产妇妊娠36周时进行，在妊娠37/38周时进行。评估新生儿结局，记录以下参数：动脉和静脉脐血pH，APGAR评分和入院新生儿重症监护病房(NICU)。在假设有或没有提前进行ECV的选择性剖腹产之间的新生儿结局没有差异的情况下，对数据进行了分析。结果:一次ECV成功率为56.3%(80/142)。在ECV成功的情况下，阴道分娩的概率为77.5%(62/80).成功进行ECV后阴道出生的新生儿的平均动脉pH为7.262（SD0.089），与通过择期剖腹产出生的人的7.316（SD0.051）相比（p<0.001）。两组在1、5和10分钟的APGAR评分相似，剖宫产组新生儿得分低于中位数的比例略高。具体来说,1分钟时13.7%(7/51)，5min时15.7%(8/51),剖腹产组10分钟时9.8%(5/51)低于中位数，与4.92%(3/61)相比，4.92%（3/61），阴道分娩组为3.28%(2/61)。阴道分娩NICU入院率为3.28％，选择性剖腹产为3.92％（p>0.05）。结论：成功进行ECV的妇女可以预期阴道分娩后的新生儿分娩结果不劣于替代性选择性剖腹产。
