未经证实:臀位出生与高缺氧损伤率相关,部分是由于出现时脐带闭塞。在生理臀位出生算法中提出了针对早期干预的最大时间间隔和指南。我们希望进一步测试和改进算法以用于临床试验。
UNASSIGNED:我们在伦敦一家教学医院进行了一项回顾性病例对照研究,包括15个病例和30个对照,2012年4月至2020年4月期间。我们的样本量足以检验超过推荐时间限制与新生儿入院或死亡相关的假设。使用SPSSv26统计软件分析从产时护理记录收集的数据。变量是劳动阶段和不同出现阶段之间的间隔(呈现部分,臀部,骨盆,武器,头)。卡方检验和比值比用于确定暴露于感兴趣的变量和复合结果之间的关联。使用多元逻辑回归来测试被定义为不遵守算法的延迟的预测值。
UNASSIGNED:使用算法时间范围的Logistic回归建模的准确率为86.8%,预测主要结局的敏感性为66.7%,特异性为92.3%.脐带和头部>3分钟之间的延迟(OR:9.508[95%CI:1.390-65.046]p=0.022)以及会阴臀部到头部>7分钟之间的延迟(OR:6.682[95%CI:0.940-41.990]p=0.058)显示出最大的效果。在这些病例中,直到第一次干预的时间长度始终更长。在病例中,干预的延迟比头部或手臂受困更常见。
UNASSIGNED:出现时间超过生理臀位出生算法中建议的限值可能是不良结局的预测因素。有些延迟是可以避免的。改善对阴道臀位分娩正常界限的认识可能有助于改善结局。
UNASSIGNED: Breech births are associated with a high rate of hypoxic injury, in part due to cord occlusion during emergence. Maximum time intervals and guidelines oriented toward earlier intervention have been proposed in a Physiological Breech Birth Algorithm. We wished to further test and refine the Algorithm for use in a clinical trial.
UNASSIGNED: We conducted a retrospective
case-control study in a London teaching hospital, including 15 cases and 30 controls, during the period of April 2012 to April 2020. Our sample size was powered to test the hypothesis that exceeding recommended time limits is associated with neonatal admission or death. Data collected from intrapartum care records was analysed using SPSS v26 statistical software. Variables were intervals between the stages of labour and various stages of emergence (presenting part, buttocks, pelvis, arms, head). The chi-square test and odds ratios were used to determine association between exposure to the variables of interest and composite outcome. Multiple logistic regression was used to test the predictive value of delays defined as non-adherence the Algorithm.
UNASSIGNED: Logistic regression modelling using the Algorithm time frames had an 86.8% accuracy, a sensitivity of 66.7% and a specificity of 92.3% for predicting the primary outcome. Delays between umbilicus and head >3 minutes (OR: 9.508 [95% CI: 1.390-65.046] p=0.022) and from buttocks on the perineum to head >7 minutes (OR: 6.682 [95% CI: 0.940-41.990] p=0.058) showed the most effect. Lengths of time until the first intervention were consistently longer among the cases. Delay in intervention was more common among cases than head or arm entrapment.
UNASSIGNED: Emergence taking longer than the limits recommended in the Physiological Breech Birth algorithm may be predictive of adverse outcomes. Some of this delay is potentially avoidable. Improved recognition of the boundaries of normality in vaginal breech births may help improve outcomes.
When babies are born bottom-first, there is a risk that the baby could be starved of oxygen during the birth. To help prevent this, researchers developed a flowchart to guide when to help a baby out, the Physiological Breech Birth Algorithm. The first version was based on a study of actual breech birth videos and recommends that the birth should be complete within 7-5-3 minutes from buttocks-pelvis-umbilicus visible. This is different from current national guidance not to intervene until 5 minutes after the baby’s pelvis is born. We are using this new algorithm to guide midwives and doctors in the OptiBreech Care Trial, so we wanted to make sure it is safe and accurate.