PDF(Pubmed)
Abstract：
OBJECTIVE: Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling).
METHODS: Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats).
METHODS: Planned community birth (homes and birth centers), United States.
METHODS: Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset.
METHODS: Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes.
METHODS: Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death.
RESULTS: One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded.
CONCLUSIONS: All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.
METHODS: Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats).
METHODS: Planned community birth (homes and birth centers), United States.
METHODS: Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset.
METHODS: Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes.
METHODS: Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death.
RESULTS: One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded.
CONCLUSIONS: All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.
摘要：
目的：调查美国计划社区分娩中与臀位表现相关的产妇和新生儿结局，包括与臀位类型相关的结果(即，Frank,完成,脚踏/跪着)。
方法：对来自国家围产期数据注册（MANAStats）的前瞻性队列数据进行二次分析。
方法：计划的社区分娩（家庭和分娩中心），美国。
方法：有术语的个人，单胎妊娠（N=71,943）在分娩时计划社区分娩。
方法：描述性统计以计算臀位类型与产妇和新生儿结局之间的关联。
方法：产妇：产时/产后转院，住院治疗,剖宫产,出血,严重的会阴裂伤,分娩阶段和胎膜破裂的持续时间新生儿：转移，住院治疗,NICU入院,先天性异常,脐带脱垂,出生伤害,产时/新生儿死亡。
结果：1%（n=695）的个体经历过臀位分娩（n=401，57.6％阴道分娩）。大多数胎儿表现出坦率的臀位（57％），完成19%，18%的脚/跪,和5%未知类型的臀位表现。在所有的臀位劳动中，与头颅表现相比，产时转移和剖宫产的发生率较高（分别为OR9.0，95％CI7.7-10.4和OR18.6，95％CI15.9-21.7），没有基于平价的实质性差异，计划的出生地点，或将护理整合到卫生系统中的水平。对于所有类型的臀位演示，几乎所有评估的新生儿结局的风险都增加，包括医院转院，NICU入院,出生伤害,和脐带脱垂.臀位表现也与产时/新生儿死亡风险增加相关(OR8.5,95%CI4.4-16.3),即使排除了先天性异常。
结论：社区分娩环境中所有类型的臀位表现都与新生儿不良结局的风险增加相关。这些研究结果有助于明智的决策，并加强了对臀位培训和研究的需求，在美国医院为计划中的阴道臀位分娩提供高质量的护理。
方法：对来自国家围产期数据注册（MANAStats）的前瞻性队列数据进行二次分析。
方法：计划的社区分娩（家庭和分娩中心），美国。
方法：有术语的个人，单胎妊娠（N=71,943）在分娩时计划社区分娩。
方法：描述性统计以计算臀位类型与产妇和新生儿结局之间的关联。
方法：产妇：产时/产后转院，住院治疗,剖宫产,出血,严重的会阴裂伤,分娩阶段和胎膜破裂的持续时间新生儿：转移，住院治疗,NICU入院,先天性异常,脐带脱垂,出生伤害,产时/新生儿死亡。
结果：1%（n=695）的个体经历过臀位分娩（n=401，57.6％阴道分娩）。大多数胎儿表现出坦率的臀位（57％），完成19%，18%的脚/跪,和5%未知类型的臀位表现。在所有的臀位劳动中，与头颅表现相比，产时转移和剖宫产的发生率较高（分别为OR9.0，95％CI7.7-10.4和OR18.6，95％CI15.9-21.7），没有基于平价的实质性差异，计划的出生地点，或将护理整合到卫生系统中的水平。对于所有类型的臀位演示，几乎所有评估的新生儿结局的风险都增加，包括医院转院，NICU入院,出生伤害,和脐带脱垂.臀位表现也与产时/新生儿死亡风险增加相关(OR8.5,95%CI4.4-16.3),即使排除了先天性异常。
结论：社区分娩环境中所有类型的臀位表现都与新生儿不良结局的风险增加相关。这些研究结果有助于明智的决策，并加强了对臀位培训和研究的需求，在美国医院为计划中的阴道臀位分娩提供高质量的护理。
