Abstract：
BACKGROUND: Over the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses.
METHODS: This retrospective population-based cohort study utilized data from the United States\' Period Linked Birth-Infant Death Public Use Files from 2008 to 2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n = 546,842) and divided into two cohorts: women who had a planned vaginal birth (n = 116,828), and women who had a planned cesarean section (n = 430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes.
RESULTS: It was observed that 26.14 % of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95 % CI 1.16-1.52, admission to NICU,1.23, 1.19-1.27, ventilation support at 〈 6 h of life, 1.47, 1.42-1.52, ventilation support at 〉 6 h of life, 1.19, 1.08-1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06-2.50.
CONCLUSIONS: In women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.
METHODS: This retrospective population-based cohort study utilized data from the United States\' Period Linked Birth-Infant Death Public Use Files from 2008 to 2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n = 546,842) and divided into two cohorts: women who had a planned vaginal birth (n = 116,828), and women who had a planned cesarean section (n = 430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes.
RESULTS: It was observed that 26.14 % of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95 % CI 1.16-1.52, admission to NICU,1.23, 1.19-1.27, ventilation support at 〈 6 h of life, 1.47, 1.42-1.52, ventilation support at 〉 6 h of life, 1.19, 1.08-1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06-2.50.
CONCLUSIONS: In women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.
摘要：
背景：在过去的几十年里，剖宫产已被推荐为臀位最安全的分娩方式。这项研究的目的是评估臀位胎儿的计划阴道分娩和计划剖宫产的结局。
方法：这项基于人群的回顾性队列研究利用了2008-2017年美国出生-婴儿死亡关联时期公共使用文件的数据。确定了所有无先天性异常的活婴儿的单胎臀位分娩（n=546,842），并分为两组：计划阴道分娩的妇女（n=116,828），和计划剖宫产的妇女（n=430,014）。多元逻辑回归模型，根据母体基线特征进行调整，检查了计划分娩方法与新生儿结局之间的关联.
结果：观察到26.14%的计划阴道分娩队列有阴道分娩。在调整后的分析中，进行计划的阴道分娩以进行臀位分娩与包括婴儿死亡在内的不良新生儿结局的风险增加相关,或1.32，95%CI1.16-1.52，入住NICU，1.23，1.19-1.27，通风支持在<6小时的寿命，1.47,1.42-1.52,>6小时寿命时的通风支持,1.19,1.08-1.31,5min时Apgar评分≤3,2.27、2.06-2.50。
结论：在臀位有胎儿的女性中，有计划的阴道分娩成功率较低,并且与新生儿发病率和死亡率的风险增加相关.应仔细咨询妇女与臀位阴道分娩相关的风险以及阴道分娩的低成功率。
方法：这项基于人群的回顾性队列研究利用了2008-2017年美国出生-婴儿死亡关联时期公共使用文件的数据。确定了所有无先天性异常的活婴儿的单胎臀位分娩（n=546,842），并分为两组：计划阴道分娩的妇女（n=116,828），和计划剖宫产的妇女（n=430,014）。多元逻辑回归模型，根据母体基线特征进行调整，检查了计划分娩方法与新生儿结局之间的关联.
结果：观察到26.14%的计划阴道分娩队列有阴道分娩。在调整后的分析中，进行计划的阴道分娩以进行臀位分娩与包括婴儿死亡在内的不良新生儿结局的风险增加相关,或1.32，95%CI1.16-1.52，入住NICU，1.23，1.19-1.27，通风支持在<6小时的寿命，1.47,1.42-1.52,>6小时寿命时的通风支持,1.19,1.08-1.31,5min时Apgar评分≤3,2.27、2.06-2.50。
结论：在臀位有胎儿的女性中，有计划的阴道分娩成功率较低,并且与新生儿发病率和死亡率的风险增加相关.应仔细咨询妇女与臀位阴道分娩相关的风险以及阴道分娩的低成功率。
