摘要
目的 探讨对臀位单胎妊娠孕妇实施外倒转术的成功率及其影响因素,并分析外倒转术的并发症发生情况. 方法 以2011年3月1日至2012年2月29日在南京大学医学院附属鼓楼医院产科定期产前检查并分娩的孕妇为研究对象,共204例孕妇纳入研究,均为单胎妊娠、妊娠32～37＋6周经超声证实为臀位、无其他剖宫产指征.其中101例孕妇不愿接受外倒转术（期待组）,嘱膝胸卧位2次/d;103例孕妇自愿接受外倒转术（外倒转术组）,于妊娠32～37＋6周实施外倒转术.比较2组孕妇分娩时转为头位的比例、剖宫产率以及胎膜早破、早产、脐带绕颈等并发症的发生率;分析外倒转术成功率的影响因素.统计学分析采用x2检验和校正x2检验. 结果 （1）外倒转术组分娩时转为头位的比例高于期待组[68.9％（71/103）与29.7％ （30/101）,x2=31.39],剖宫产率低于期待组[49.5％（51/103）与78.2％（79/101）,x2=18.18],臀位为剖宫产第一指征的比例也低于期待组[62.7％ （32/51）与89.9％ （71/79）,x2=13.86],差异均有统计学意义（P值均＜0.05）.（2）单臀位、完全臀位与不完全臀位的外倒转术成功率分别为77.1％（37/48）、72.7％（24/33）与45.5％（10/22）,3组间比较差异有统计学意义（x2=7.37,P＜0.05）,单臀位成功率高于不完全臀位（x2=6.84,P＜0.017）.比较初产妇与经产妇[67.7％（63/93）与8/10]、前壁胎盘与非前壁胎盘[61.0％（25/41）与74.2％ （46/62）]、妊娠32～35＋6周与36～37＋6周[70.5％（62/88）与9/15]实施外倒转术的成功率,差异均无统计学意义（x2分别为0.19、2.01和0.65,P值均＞0.05）.（3）外倒转术组与期待组的胎膜早破发生率[7.8％（8/103）与6.9％（7/101）]、早产率[2.9％（3/103）与2.0％ （2/101）]、脐带绕颈发生率[17.5％（18/103）与21.8％ （22/101）]比较,差异均无统计学意义（x2分别为0.05、0.19和0.60,P值均＞0.05）. 结论 对臀位单胎妊娠孕妇实施外倒转术,可有效矫正胎位,降低剖宫产率.妊娠32周后行外倒转术并不增加胎膜早破和早产的风险.
Objective To discuss the success rate of external cephalic version （ECV） for breech presentation in singleton pregnancies and the factors influencing ECV,and complications induced by ECV.Methods A prospective study was conducted which included 204 pregnant women who underwent regular prenatal examinations and delivered in Nanjing Drum Tower Hospital between March 1,2011 and February 29,2012.The 204 cases were single pregnancy with breech presentation identified by ultrasound during 32-37＋6 weeks of gestation,and without other indications for cesarean section （CS）.According to willingness of the participants,204 cases were divided into two groups.The 101 pregnant women who refused EVC （control group） were asked to practice knee-chest position twice a day; and 103 pregnant women volunteered to undergo EVC （ECV group） during 32-37＋6 weeks of gestation.The proportion of cephalic presentation at delivery,CS rate and the incidence of PROM,premature delivery and cord around the neck were compared between the two groups.Factors influencing the success rate of ECV were analyzed.Chi-square or adjusted Chi-square test were used for statistical analysis.Results The proportion of cephalic presentation at delivery in the ECV group was higher than that in the control group [68.9％ （71/103） vs 29.7％ （30/101）,x2=31.39]; the CS rate in the ECV group was lower than that in the control group [49.5％ （51/103） vs 78.2％ （79/101）,x2=18.18],as was the rate of CS due to breech presentation [62.7％ （32/51） vs 89.9％ （71/79）,x2=13.86],all P＜0.05.The success rates in frank breech presentation,complete breech presentation and incomplete breech presentation were 77.1％ （37/48）,72.7％ （24/33） and 45.5％ （10/22）,respectively （x2=7.37,P＜0.05）,and the success rate in frank breech presentation was higher than that in incomplete breech presentation （x2=6.84,P＜0.017）.No significant differences were observed in the success rates between primiparas and multiparas [67.7％ （63/93） vs 8/10,x2=0.19],placenta attached at front wall of uterus and other attachment sites [61.0％ （25/41） vs 74.2％ （46/62）,x2=2.01],and EVC performed at 32-35＋6weeks of gestation and 36-37＋6 weeks [70.5％ （62/88） vs 9/15,x2=0.65],allP＞0.05.No significant differences were observed for the incidence of PROM [7.8％ （8/103） vs 6.9％ （7/101）],premature delivery [2.9％ （3/103） vs 2.0％ （2/101）] and cord around the neck [17.5％ （18/103） vs 21.8％ （22/101）] between the ECV and control group （x2=0.05,0.19 and 0.60,all P＞0.05）.Conclusions ECV for breech presentation in singleton pregnancies can effectively correct the fetal position and reduce the CS rate.ECV performed after 32 weeks of gestation does not increase the risk of PROM and premature delivery.
出处
《中华围产医学杂志》
CAS
北大核心
2014年第3期169-172,共4页
Chinese Journal of Perinatal Medicine
关键词
臀先露
倒转术
胎位
胎膜早破
早产
Breech presentation
Version, fetal
Fetal membranes, premature rupture
Premature birth
