摘要
目的:探讨足月臀位外倒转术成功的相关因素。方法:以2014年4月至2017年4月在首都医科大学附属北京妇产医院定期产检的≥孕37周单胎臀位行外倒转术(均行椎管内麻醉)的孕妇149例为研究对象,按照倒转成功与否分为成功组和失败组,将相关因素(产妇年龄、产次、孕周、体质量指数、脐带长度、羊水指数、新生儿体质量、臀先露类型、绕颈与否、胎盘位置、是否使用宫缩抑制剂)行单因素分析和Logistic回归多因素分析。结果:149例行足月臀位外倒转术的孕妇中,成功59例,成功率39.60%。单因素分析结果提示:成功组(59例)与失败组(90例)脐带长度(54.00±5.92 cm vs 49.89±9.95 cm)和产次(初产妇与经产妇)差异有统计学意义(P<0.05)。多因素分析结果提示:产次、宫缩抑制剂、脐带长度是足月臀位外倒转手术成功的影响因素(P<0.05)。结论:多学科联合下进行足月臀位外倒转术是安全可行的,其成功的相关因素可能与产次、使用宫缩抑制剂和脐带长度有关。选择合适的病例,术前使用宫缩抑制剂,建议行椎管内麻醉,术中及术后加强观察和母儿监护,以达到安全分娩的目的。
Objective:To discuss the factors affecting the success of external cephalic version(ECV)for term breech presentation.Methods:149 pregnant women who underwent regular prenatal examinations and delivered in Beijing Obstetrics and Gynecology Hospital between April 2014 and April 2017 were enrolled in this study.They were all singleton pregnancies with breech presentation and received ECV under intraspinal anesthesia.They were divided into success group and failure group.The related factors[maternal age,parturition number,gestational age,body mass index(BMI),umbilical cord length,amniotic fluid index,birth weight,type of breech presentation,cord around neck or not,placental location,tocolytics usage]were analyzed by single factor analysis and logistic regression.Results:In the 149 cases of ECV,59 cases were successful(39.60%).Univariate analysis showed that there were significant differences in umbilical cord length(54.00±5.92 cm vs 49.89±9.95 cm)and parity(primipara and multipara)between successful and failed group(P<0.05).Multivariate analysis showed that multipara,umbilical cord length and usage of tocolytics were the main factors influencing the success of ECV for breech presentation(P<0.05).Conclusions:Full-term ECV is a safe and feasible procedure under multidisciplinary cooperation.The successful factors are related to the number of births,the use of tocolytics and the length of umbilical cord.Appropriate choice of suitable cases,usage of tocolytics before operation and intraspinal anesthesia are recommended.Intraoperative and postoperative observation and maternal and fetal monitoring are important to achieve the goal of safe delivery.
作者
马翠
伍绍文
刘晓巍
MA Cui;WU Shaowen;LIU Xiaowei(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2019年第6期445-449,共5页
Journal of Practical Obstetrics and Gynecology
基金
国家科技支撑计划课题(编号:2015BAI13B04)
关键词
臀位
足月
胎位
外倒转术
Breech presentation
Full term
Fetal position
External cephalic version
