摘要
目的探讨超声引导下孕晚期臀位外倒转术成功的影响因素。方法70例行B超引导下孕晚期臀位外倒转术的产妇,按外倒转术成功与否分为对照组(外倒转术失败,15例)和研究组(外倒转术成功,55例)。比较两组胎膜早破发生情况及分娩方式,统计不良事件发生情况,分析B超引导下孕晚期臀位外倒转术失败的原因、B超引导下孕晚期臀位外倒转术成功的影响因素。结果对照组产妇中有1例(6.67%)发生胎膜早破,15例(100.00%)产妇均择期剖宫产分娩;研究组产妇中有5例(9.09%)发生胎膜早破,3例(5.45%)择期剖宫产分娩,52例经阴道分娩;两组胎膜早破发生率比较差异无统计学意义(P>0.05);研究组产妇择期剖宫产率低于对照组,差异具有统计学意义(P<0.05)。两组均未发生新生儿窒息、急诊剖宫产等不良事件。B超引导下孕晚期臀位外倒转术产妇中失败15例,导致失败的原因有5个,最主要的2个原因是剧烈疼痛无法忍受、腹部肌肉紧张和可忍受疼痛、腹部肌肉紧张、多次失败,占比分别为46.7%、33.3%。两组胎儿预估体质量、胎臀入盆率、臀位类型、羊水指数(AFI)、产次、孕周、体质量指数(BMI)、年龄对比差异均无统计学意义(P>0.05);研究组胎头易触及率87.3%、胎盘位置非前壁率69.1%、无脐带绕颈率56.4%、低腹壁张力率74.5%均高于对照组的60.0%、40.0%、26.7%、33.3%,腹壁脂肪厚度(1.11±0.30)cm薄于对照组的(1.83±0.40)cm,差异具有统计学意义(P<0.05)。以胎头易触及与否、胎盘位置、脐带绕颈、腹壁张力、腹壁脂肪厚度为自变量,以外倒转术是否成功作为因变量,成功为1,失败为0,行多因素Logistic回归分析显示,胎头易触及、胎盘位置非前壁、无脐带绕颈、低腹壁张力、腹壁脂肪厚度薄是B超引导下孕晚期臀位外倒转术成功的独立保护因素(P<0.05)。结论臀位外倒转术属于安全性较高的手术,将臀位外倒转术应用在孕晚期单胎臀位产妇中成功率相对较高,其中手术成功的影响因素有胎头易触及、胎盘位置非前臂、无脐带绕颈、低腹壁张力、腹壁脂肪厚度薄,同时,该手术一定程度上会增加胎膜早破的风险,因此,对临床操作予以进一步规范,实施针对性干预措施,为无明显顺产禁忌的孕晚期臀位产妇应用B超引导下臀位外倒转术,能够有效提高成功率、安全性。
Objective To discuss the factors influencing the success of ultrasound-guided external cephalic version of breech presentation in late pregnancy.Methods A total of 70 women who underwent ultrasound-guided external cephalic version of breech presentation in late pregnancy were divided into control group(failure of external cephalic version,15 cases)and research group(success of external cephalic version,55 cases)according to the success of external cephalic version.The occurrence of premature rupture of membranes and the mode of delivery were compared between the two groups,the adverse events were counted,and the reasons for the failure of ultrasound-guided external cephalic version of breech presentation in late pregnancy and the factors influencing the success of ultrasound-guided external cephalic version of breech presentation in late pregnancy were analyzed.Results In the control group,there was 1 case(6.67%)of premature rupture of membranes,and 15 cases(100.00%)of elective cesarean section;in the research group,there were 5 cases(9.09%)of premature rupture of membranes,3 cases(5.45%)of elective cesarean section and 52 cases of vaginal delivery;the differences in the incidence of premature rupture of membranes between the two groups were not statistically significant(P>0.05).The rate of elective cesarean section in the research group was lower than that in the control group,and the difference was statistically significant(P<0.05).No adverse events such as neonatal asphyxia and emergency cesarean section occurred in the two groups.There were 15 failed cases of ultrasound-guided external cephalic version of breech presentation in late pregnancy,resulting in 5 reasons for failure,the 2 most important reasons being intolerable severe pain,abdominal muscle tension and tolerable pain,abdominal muscle tension,and multiple failures,accounting for 46.7%and 33.3%,respectively.There were no statistically significant differences between the two groups in terms of fetal estimated body weight,fetal breech incidence,type of breech presentation,amniotic fluid index(AFI),parity,gestational age,body mass index(BMI)and age(P>0.05).In the research group,87.3%of the fetal head was easily accessible,69.1%of the placenta was not anteriorly located,56.4%of the cord was not wrapped around the neck,and 74.5%of the low abdominal wall tension,which were higher than those of 60.0%,40.0%,26.7%,and 33.3%in the control group;the abdominal wall fat thickness of(1.11±0.30)cm in the research group was thinner than that of(1.83±0.40)cm in the control group;the differences were statistically significant(P<0.05).Accessibility of fetal head or not,placenta location,umbilical cord around neck,abdominal wall tension and abdominal wall fat thickness were independent variables,while success of external conversion was 1 and failure was 0 as dependent variables.Multivariate Logistic regression analysis showed that accessibility of fetal head,non-anterior placental position,no umbilical cord around the neck,low abdominal wall tension,thin abdominal wall fat thickness were independent protective factors for the success of ultrasound-guided external cephalic version of breech presentation in late pregnancy(P<0.05).Conclusion The success rate of external cephalic version of breech presentation is relatively high in parturient with a breech singleton pregnancy in late pregnancy.The factors affecting the success of the procedure include accessibility of fetal head,non-anterior placental position,no umbilical cord around the neck,low abdominal wall tension,and thin abdominal wall fat thickness.At the same time,this procedure will increase the risk of premature rupture of membranes to some extent.Therefore,further standardization of clinical practice,implementation of targeted interventions,and application of ultrasound-guided external cephalic version of breech presentation for late pregnancy breech mothers with no obvious contraindications to normal delivery can effectively improve the success rate and safety.
作者
冯小红
周回燕
黄辉
FENG Xiao-hong;ZHOU Hui-yan;HUANG Hui(Department of Obstetrics,Guangdong Gaozhou People's Hospital,Gaozhou 525200,China)
出处
《中国实用医药》
2023年第11期68-72,共5页
China Practical Medicine
基金
茂名市科技计划项目(项目编号:210406214552408)。
关键词
超声引导
臀位
外倒转术
孕晚期
成功率
影响因素
Ultrasound-guided
Breech presentation
External cephalic version
Late pregnancy
Success rate
Influencing factors
