目的:关于足月臀位最安全的分娩方式的争论仍未解决。阴道臀位分娩(VBB)与选择性剖腹产(CS)在胎儿结局方面的比较有利于CS。然而,本研究探讨了尝试VBB是否与不良胎儿结局相关的问题.此外,该研究评估了导致VBB成功的因素,并说明了VBB管理中可能存在的错误。
方法:我们对围产期中心I级足月臀位出生的胎儿,母性,通过比较成功与不成功的VBB尝试以及所有尝试的VBB与产科结果CS包括成功VBB的预测因子的多变量分析。进行了严重不良事件(SAE)的根本原因分析,以评估导致VBB胎儿结局较差的因素。
结果:在863例臀位病例中,在78%中进行了CS,在22%中尝试了VBB,57%的人成功了。比较成功与不成功的VBB尝试,成功的VBB显示显着降低母体失血量(p<0.001),但脐动脉pH值(UApH)较差(p<0.001),而其他胎儿结局参数无显著差异。成功尝试VBB的预测因素是体重指数(BMI)低于30.0kg/m2(p=0.010)和多奇偶校验(p=0.003)。将所有尝试的VBB与CS进行比较,母亲失血率明显高于CS(p<0.001),虽然VBB尝试的胎儿结局明显更差,包括较差的Apgar评分(p<0.001),UApH值较差(p<0.001),新生儿重症监护病房(NICU)的转移率较高(p<0.001),并且在最初24小时内呼吸支持的发生率较高(p=0.003)。
结论:VBB失败的尝试表明UApH明显恶化,没有降低Apgar评分或更高的NICU转移率。肥胖患者成功VBB的可能性降低9%,多胎妇女的可能性提高2.5倍。尝试VBB应该包括详细的劳动前咨询,关于预测成功因素,一个经验丰富的团队,和出生时的一致管理。
OBJECTIVE: The debate about the safest birth mode for breech presentation at term remains unresolved. The comparison of a vaginal breech birth (VBB) with an elective caesarean section (CS) regarding fetal outcomes favors the CS. However, the question of whether attempting a VBB is associated with poorer fetal outcomes is examined in this study. Additionally, the study evaluates factors contributing to a successful VBB and illustrates possible errors in VBB management.
METHODS: We performed a retrospective analysis of term breech births over 15 years in a Perinatal Center Level I regarding fetal, maternal, and obstetric outcomes by comparing successful with unsuccessful VBB attempt and all attempted VBB vs. CS including a multivariate analysis of predictors for a successful VBB. A root cause analysis of severe adverse events (SAE) was conducted to evaluate factors leading to poorer fetal outcomes in VBB.
RESULTS: Of 863 breech cases, in 78 % a CS was performed and in 22 % a VBB was attempted, with 57 % succeeding. Comparing successful with unsuccessful VBB attempts, successful VBB showed significantly lower maternal blood loss (p < 0.001) but poorer umbilical arterial pH (UApH) (p < 0.001), while other fetal outcome parameters showed no significant differences. Predictive factors for a successful VBB attempt were a body mass index (BMI) below 30.0 kg/m2 (p = 0.010) and multiparity (p = 0.003). Comparing all attempted VBB to CS, maternal blood loss was significantly higher in CS (p < 0.001), while fetal outcomes were significantly worse in VBB attempts, included poorer Apgar scores (p < 0.001), poorer UApH values (p < 0.001), higher transfer rate to the Neonatal Intensive Care Unit (NICU) (p < 0.001) and higher rate of respiratory support in the first 24 h (p = 0.003).
CONCLUSIONS: The failed attempt of VBB indicates significantly worse UApH without lower Apgar scores or higher transfer rate to the NICU. The likelihood of a successful VBB is 9% lower with obesity and 2.5 times higher in multiparous women. Attempting a VBB should include detailed pre-labor counseling, regarding predictive success factors, an experienced team, and consistent management during birth.