提供有关外部头部版本(ECV)尝试的效率和安全性的指南以及将臀位婴儿转变为头部表现的替代方法。
MedLine和CochraneLibrary数据库以法语和英语进行搜索,并审查1980年至2019年之间的主要外国指南。
ECV与出生时臀位(LE2)的下降率有关,并且可能具有较低的剖宫产率(LE3),而不增加重度产妇(LE3)和围产期发病率(LE3)。因此,建议在学期以臀位介绍的方式告知女性应尝试ECV(专业共识)。ECV尝试应立即进入手术室进行紧急剖宫产(专业共识)。在37周之前的ECV尝试,与37周后的ECV尝试相比,增加了出生时头端表现(LE2)的发生率,但中度早产(LE2)的风险略有增加。ECV尝试应从36SA(专业共识)进行。与成功尝试ECV相关的主要因素是多胎(LE3)和无母亲肥胖(LE3)。肠胃外溶解(β模拟或阿托西班),对于ECV尝试,足月与更高的成功率(LE2)相关,产程中头颅表现的发生率较高(LE2),剖宫产率较低(LE2)。建议在足月进行ECV尝试时使用肠胃外分娩,以提高其成功率(B级)。ECV尝试与短暂性FHR异常(LE3)的增加有关,因此,建议在手术前和手术后30分钟内进行心电图检查(专业共识).没有理由建议在尝试ECV后进行延迟心电图检查(专业共识)。ECV尝试后Kleihauer试验的显著阳性(>30mL)风险较低(<0.1%)(LE3),不建议在尝试ECV后系统地进行Kleihauer测试(专业共识).如果RH-1阴性的女性,建议确保系统的RH-1预防(专业共识).如果在学期出现臀位,针灸,艾灸和体位方法不能有效减少出生时的臀位(LE2),因此不推荐(B级)。
根据ECV尝试的明显好处和低风险,应告知所有足月有臀位的女性,应尝试ECV以减少分娩和剖宫产时的臀位.
To provide
guidelines regarding efficiency and safety of external cephalic version (ECV) attempt and alternatives methods to turn
breech babies to cephalic presentation.
MedLine and Cochrane Library databases search in French and English and review of the main foreign
guidelines between 1980 and 2019.
ECV is associated with a decreasing rate of breech presentation at birth (LE2), and potentially with a lower rate of cesarean section (LE3) without an increase of severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV should be attempt (Professional
consensus). ECV attempt should be performed with immediate access to an operating room for emergency cesarean (Professional
consensus). The ECV attempt before 37 weeks, compared to ECV attempt after 37 weeks, increases the rate of cephalic presentation at birth (LE2) but with a small increase risk of moderate prematurity (LE2). ECV attempt should be performed from 36SA (Professional
consensus). The main factors associated with successful ECV attempt are multiparity (LE3) and no maternal obesity (LE3). Parenteral tocolysis (β mimetic or atosiban), for ECV attempt at term is associated with a higher success rate (LE2), higher rate of achieved cephalic presentation in labor (LE2) and a lower cesarean section rate (LE2). It is recommended to use parenteral tocolysis for ECV attempt at term in order to increase its success rate (grade B). The ECV attempt is associated with an increase in transient FHR abnormalities (LE3), it is therefore recommended that cardiotocography should be performed prior and during 30minutes after the procedure (Professional
consensus). There is no argument for recommending the practice of delayed cardiotocography after ECV attempt (Professional
consensus). The risk of significant positivity (>30mL) of the Kleihauer test after ECV attempt is low (<0.1%) (LE3), it is not recommended to systematically perform a Kleihauer test after ECV attempt (professional consensus). In case of RH-1 negative women, it is recommended to ensure systematic RH-1 prophylaxis (Professional
consensus). In case of breech presentation at term, acupuncture, moxibustion and postural methods are not effective in reducing breech presentation at birth (LE2), and are therefore not recommended (Grade B).
According to the clear benefits and the low risks of ECV attempt, all women with a breech presentation at term should be informed that ECV should be attempted to decrease breech presentation at birth and cesarean section.