本章的目的是在现有知识的基础上,研究分娩前选择有资格接受阴道分娩试验的妇女的标准。
1980年至2019年之间使用Medline和Cochrane数据库以及国际学会的建议进行法语和英语的书目研究。
建议为希望在足月尝试阴道分娩的女性提供骨盆测量,以决定其分娩方式(C级)。PREMODA研究时使用的骨盆标准为入口前后直径≥105mm,入口的横向直径≥120mm,横向棘突间直径≥100mm。然而,因为没有证据表明使用哪种骨盆措施,也没有任何证据来设定决策阈值,而不是发表的研究中设定的阈值,选择的决策阈值可以根据分娩时的胎龄或胎儿生物识别技术进行调整(专业共识).在37周孕龄之前分娩的情况下(专业共识)和在分娩开始时发现的臀位表现的情况下,没有理由建议使用骨盆测量。没有单独的骨盆测量并不妨碍阴道分娩的尝试(专业共识).没有足够的数据来建议系统地使用胎儿体重估计和/或双顶直径测量作为阴道分娩尝试的接受标准。如果出生前已知的胎儿体重估计大于3800g,剖宫产是首选(专业共识)。臀位表现本身并不是试图将小胎儿阴道分娩的禁忌症(专业共识)。非坦率的臀位本身并不是尝试阴道分娩的禁忌症(专业共识)。在臀位早产的情况下,当前数据不允许推荐一种交付路线而不是另一种(专业共识)。建议在尝试阴道分娩之前通过超声检查胎儿头部没有过度伸展(专业共识),如果发现这种位置,则建议选择剖宫产(专业共识)。不建议提出以无胎(C级)为唯一原因的剖腹产。在胎儿臀位表现的情况下,剖宫产史本身并不是尝试阴道分娩的禁忌症(专业共识)。胎膜早破本身并不是尝试阴道分娩的禁忌症(专业共识)。
本章中分析的许多因素将被纳入决策过程,以便与胎儿在臀位的妇女一起选择分娩途径。
The objective of this chapter is to examine on the basis of the knowledge currently available the criteria available before labour for selecting women who would be eligible for trial of vaginal delivery.
Bibliographical research in French and English using the Medline and Cochrane databases between 1980 and 2019 and the recommendations of international societies.
It is recommended to offer women who wish to attempt a vaginal delivery at term a pelvimetry to decide with them on their mode of delivery (Grade C). The pelvimetric standards used at the time of the PREMODA study were anteroposterior diameter of inlet≥105mm, a transverse diameter of inlet≥120mm, a transverse interspinous diameter≥100mm. However, since there is no evidence about which pelvic measures to use, nor any evidence to set decision-making thresholds other than those set in published studies, the selected decision-making thresholds can be adjusted according to gestational age at delivery or fetal biometrics (Professional consensus). There is no argument for recommending the practice of pelvimetry in the case of delivery before 37 weeks gestational age (Professional consensus) and in the case of breech presentation discovered at the time of beginning of labour, the absence of pelvimetry alone does not contraindicate the attempt of vaginal delivery (Professional consensus). There is insufficient data to recommend the systematic use of fetal weight estimation and/or biparietal diameter measurement as acceptance criteria for a vaginal delivery attempt. In the event of a known fetal weight estimation before birth greater than 3800g, a cesarean section is to be preferred (Professional consensus). The breech presentation is not in itself a contraindication to an attempt of vaginal delivery for a small fetus for gestational age (Professional consensus). The presentation of the non-frank breech is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus). In the case of premature breech delivery, current data do not allow to recommend one delivery route over another (Professional consensus). It is recommended to check the absence of hyperextension of the fetal head by ultrasound before an attempt of vaginal delivery (Professional consensus) and to prefer a cesarean section if such a position is found (Professional consensus). It is not recommended to propose a caesarean section with the sole reason of nulliparity (Grade C). The history of cesarean section is not in itself a contraindication to an attempt of vaginal delivery in the case of fetal breech presentation (Professional consensus). Premature rupture of the membranes is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus).
A number of the factors analyzed in this chapter are to be incorporated into the decision-making process in order to choose with the woman whose fetus is in breech presentation the delivery route.