多学科联合对足月单胎臀位外倒转43例临床分析

目的:探讨多学科联合对足月单胎臀位外倒转术的可行性及安全性。方法:≥孕37周的43例单胎臀位孕妇,在多学科联合下由受过严格训练的施术者进行外倒转术。结果:43例孕妇外倒转成功35例(81.4%),8例失败;阴道分娩27例(62.8%),剖宫产16例(37.2%),无一例回复及出现严重母婴并发症。结论:在多学科联合下,对足月单胎臀位孕妇行外倒转术是安全、可行的。     

臀位改良倒转术—附669例报告

对妊娠30－40周单胎臀位，具有倒转术适应证的669例孕妇，术前半－1小时，口服硫酸舒喘灵4．8mg，术中根据臀先露类型，先露部进入骨盆腔的深度，选用外倒转术或／和阴道－腹部双合倒转术矫正臀位，术后又采用综合措施防治臀位复变，手术成功率为96．71％，单胎臂位发生率，剖宫产率，臀位剖宫产率等质量指标，经统计学验证，较未行手术矫正前有显著降低，尚未发手术并发症。     

对臀位外倒转术成功与否的预测

臀位外倒转术由于并发症发生率高,并且未能改善相对较高的自然回转率,其应用日见减少。至80年代,足月妊娠时臀位外倒转术的应用又得以恢复,其成功率为60％～70％,相应地减少了臀位产及因之而行的剖宫产数。 一些研究试图确定影响外倒转术成败的母儿因素,但大多数仅注重了某一因素的重要性,因而其研究结果常相互矛盾。作者通过回顾性分析,建立了一个预测外倒转术成功的评分系统,并对该系统进行了前瞻性检验。 资料来自南卡罗来那医科大学行外倒转术的108位单胎妊娠妇女。病人入院时行超声检查、NST及盆腔检查。确定胎位、羊水量,估计胎儿体重,以及发现明显的胎儿畸形和胎盘定位。胎盘位置分为:前壁、后壁、宫底及侧壁胎盘。NST     

基于人工神经网络的臀位外倒转术疗效预测模型研究

目的构建基于人工神经网络的臀位外倒转术疗效预测模型,分析其应用价值。方法选取2017年1月至2020年6月在南方医科大学附属东莞人民医院行臀位外倒转术的孕产妇为研究对象,收集临床和影像资料数据,应用多层感知器(MLP)神经网络技术建立臀位外倒转术疗效预测模型,以预测准确率和ROC曲线为指标评价其预测效能。结果共纳入有效样本316例,经外倒转术成功纠正胎位239例。构建的MLP神经网络模型在测试集中的预测准确率为86%,ROC曲线下面积为0.816。结论人工神经网络模型在臀位外倒转术疗效预测方面具有应用潜力,值得深入研究。     

B型超声诊断仪监视下行外倒转术

Ｂ型超声诊断仪监视下行外倒转术莫娥清，庚慧鸣臀位、横位围产儿死亡比头位产明显增高。为降低围产儿的死亡率对臀位、横位矫正为头位方法很多，外倒转术是其中之一。过去此法带有一定的盲目性。自１９９１年１月至１９９４年１２月我院采用Ｂ型超声监视下行外倒转术１０...     

成功的臀位外倒转术对分娩方式及母儿结局的影响

目的:探讨妊娠晚期成功的臀位外倒转术对分娩方式及母儿结局的影响。方法:选择2016年1月至2018年5月在中山大学附属第三医院产前检查并分娩的产妇452例,其中妊娠晚期胎位臀位且自愿选择行外倒转术的产妇134例,外倒转术成功且至分娩时胎位仍为头位的80例产妇为外倒转术组,另选择同期胎位头位选择阴道分娩的318例产妇作为对照组,进行随访观察,比较两组产妇的分娩方式及母儿结局。结果:外倒转术组产妇的剖宫产率(15.00%)和紧急剖宫产率(12.50%)明显高于对照组的剖宫产率(5.35%)和紧急剖宫产率(4.72%),差异均有统计学意义(P0.05)。两组产妇的引产率、阴道助产率、羊水浑浊率及产后出血情况比较,差异均无统计学意义(P0.05)。两组新生儿死亡率、新生儿窒息率、Apgar 1分钟评分、Apgar 5分钟评分、脐动脉血PH值及碱剩余比较,差异均无统计学意义(P0.05)。结论:经臀位外倒转术成功后的产妇虽剖宫产率较普通头位产妇略有升高,但其他方面对产妇和新生儿无明显影响,臀位外倒转术仍为改变胎位、提高阴道分娩率的重要手段。     

妊娠晚期臀位用宫缩抑制剂行外倒转术的讨论

在围产期,臀位的危险性很大。处理臀位是产科重要课题之一,轻易采用剖宫产亦非良策。历来减少臀位分娩的方法之一是在妊娠8～9个月之间行臀位外倒转术。为避免因外倒转引起的早产、早破水,胎盘早剥、脐带扭转等所致的胎死宫内,减少再复臀位率,1975年Saling等提出将施术时间放在孕37周后,并在胎心监护下进行妊娠晚期臀位外倒转术(late external cep halic version,简称lateEC V),认为是一种新的臀位处理法。作者的临床实施结果如下: 对象为1983年7月～1986年9月间妊娠36周以后的臀位22倒。其中单(伸腿)臀14例,混合臀位8例。     

臀位外倒转术605例临床分析

1982年以来我院对臀位施行外倒转术,今将有记载的605例作一报道。临床资料一、一般资料本组病例均系我院门诊产前检查的孕妇,其中初孕妇587例,经产妇18例;臀位592例,横位13例;倒转成功484例,失败121例。本组施行外倒转成功组的孕周分布见表1。除少数病例初诊时孕周已大,立即作外倒转术外,一般先做膝胸卧位一     

单胎臀位外倒转术的影响因素分析

目的探讨影响单胎臀位外倒转术成功率的相关因素。 方法对2015年11月至2016年4月就诊于广州医科大学附属第三医院妇产科进行外倒转术的20例单胎孕妇的临床资料进行回顾性分析,患者均为单胎妊娠,孕龄在35～38周之间,不合并绝对剖宫产指征,均愿接受行外倒转术。分析影响外倒转术成功率的相关因素,统计学采用χ²检验。 结果20例外倒转术有14例(70%)完成倒转,其中12例(60%)倒转成功并经阴道分娩。比较单臀位和复合臀位[7/9例与7/11例],初产妇及经产妇[5/8例与9/12例]、胎盘位于前壁、后壁和宫底[5/8例,6/8例与3/4例]、妊娠足月与否[4/6例与10/14例]、羊水量正常与否[12/17例与2/3例]、脐带绕颈与否[2/4例与12/16例]的外倒转成功率,差异无统计学意义(P>0.05)。胎儿窘迫、胎盘早剥和早产的发生率分别为10.0%(2/20)例、5.0%(1/20)例和2/14例。 结论外倒转术能较为安全有效将臀位转为头位,适用于足月或近足月妊娠,可达到降低剖宫产率的目的。     

对臀位外倒转术的评价

关于臀位的处理.无论是产前需否协助纠正胎位,或者采取何种分娩方式,至今仍是一个有争论的问题。关于产前需否做外倒转术,亦即究竟外倒转能否降低臀位分娩率,文献所述意见不一。这里涉及单胎臀位妊娠有多少在孕末期可自然回转成头位。     

Antepartum external cephalic version under tocolysis

Reported are 172 patients considered for external cephalic version at gestational age greater than 37 weeks. Their outcome was compared with 40 similar patients in whom external version was not attempted. One hundred fifty-eight patients had attempted version, and success was achieved in 122 (77%). Intrapartum vertex presentation occurred in 12% of the control population and in 77% of the version patients. Cesarean section was performed in 80% of the control patients and in 32% of the version patients. There were no maternal or fetal complications directly attributable to external cephalic version. Antepartum external cephalic version under tocolysis is associated with a high success rate, an acceptably low rate of complications, and a decreased incidence of cesarean section for breech presentation at term.     

Effect of external cephalic version in late pregnancy on presentation at delivery: a randomized controlled trial

Summary. The effect of repeated external cephalic version, performed at between 33 and 40 weeks gestation, on presentation at delivery was studied in a randomized controlled trial comprising 180 pregnant women with breech presentation. No tocolysis, analgesia or anaesthesia was used. Approximately 25% of all attempts in the study group of 90 women were successful; repeated external version resulted in cephalic presentation at delivery in 48% of patients. Spontaneous version to cephalic presentation occurred in 23 (26%) of the 90 women in the control group in whom version was not attempted, indicating a therapeutic gain from the procedure of 22%, with a 95% confidence interval of 8 to 35%. No severe complications of external cephalic version were noted. We conclude that external cephalic version reduces the frequency of breech presentation at delivery. This mainly benefits the mother because of the decrease in the number of caesarean sections and their inherent maternal morbidity.     

Effect of external cephalic version in late pregnancy on presentation at delivery: a randomized controlled trial

The effect of repeated external cephalic version, performed at between 33 and 40 weeks gestation, on presentation at delivery was studied in a randomized controlled trial comprising 180 pregnant women with breech presentation. No tocolysis, analgesia or anaesthesia was used. Approximately 25% of all attempts in the study group of 90 women were successful; repeated external version resulted in cephalic presentation at delivery in 48% of patients. Spontaneous version to cephalic presentation occurred in 23 (26%) of the 90 women in the control group in whom version was not attempted, indicating a therapeutic gain from the procedure of 22%, with a 95% confidence interval of 8 to 35%. No severe complications of external cephalic version were noted. We conclude that external cephalic version reduces the frequency of breech presentation at delivery. This mainly benefits the mother because of the decrease in the number of caesarean sections and their inherent maternal morbidity.     

Effect of external cephalic version at term on fetal circulation

OBJECTIVE: We sought to investigate the subclinical effect of external cephalic version on fetal circulation.Study Design: A prospective observational study was conducted on 136 subjects who had external cephalic version at or beyond 36 weeks of gestation without clinical complication. Doppler ultrasonographic studies of the umbilical and middle cerebral circulations were performed before and after the external cephalic version. The following Doppler indexes were measured: (1) the pulsatility index of the umbilical artery, which represents disturbance of placental circulation, and (2) the pulsatility index of the fetal middle cerebral artery, which represents fetal response. The Wilcoxon signed rank test was used for all statistical analyses. RESULTS: There was no significant difference in pulsatility index of the umbilical artery before and after external cephalic version (P =.674). There was a statistically significant reduction in the pulsatility index of the middle cerebral artery after external cephalic version (P =.043), and this difference existed only among multiparous women (P =.029), among those in whom the external cephalic version was considered to be difficult (P =.038), and when the placenta was posteriorly located (P =.028). The reduction in pulsatility index was not related to whether the external cephalic version was successful. In all cases the Doppler indexes remained within the normal ranges, and there were no associated fetal complications. CONCLUSION: External cephalic version was not associated with any significant disturbance of placental resistance to blood flow. Conversely, external cephalic version was associated with a significant reduction in the pulsatility index of the middle cerebral circulation, especially among the multiparous women, after a difficult procedure or in those with a posterior placenta. This probably represents a normal fetal physiologic response to manipulation of the fetal head.     

Intrapartum external cephalic version of footling-breech presentation

BACKGROUND: External cephalic version is attempted prior to the onset of labor. Women who present in labor with footling breech presentation are usually delivered by cesarean section. We present our experience of external version in women in labor. MATERIAL AND METHODS: External cephalic version was attempted in thirteen patients in labor with footling breech presentation with the breech out of the pelvis. RESULTS: The procedure was successful in twelve of the thirteen patients. Ten of them delivered vaginally. There were no maternal or neonatal complications. CONCLUSIONS: It may be reasonable to attempt external cephalic version in patients in labor prior to performing a cesarean section.     

Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004

BACKGROUND: Probabilistic information on outcomes of breech presentation is important for clinical decision-making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. METHODS: We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997-2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. RESULTS: Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy-one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset-of-labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. CONCLUSIONS: Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation.     

The benefit of external cephalic version with tocolysis as a routine procedure in late pregnancy.

The effectiveness of external cephalic version with tocolysis when routinely used in the 37th week of gestation is reported. The procedure had earlier been ruled out in our department, was found effective in a prospective study, and afterwards settled as a routine. Among 1038 women with single breech presentation, 882 could be offered an attempt of external cephalic version during the period 1982-1988. Attempt of version was carried out in 316 women resulting in a vertex presentation at delivery in 100. The success rate on average was 35%. The estimated reduction of breech deliveries was 100/1038 = 9.6%. As the mean caesarean section rate in women with breech presentation was 81% during the period studied, the estimated reduction in the number of caesarean sections during those seven years was 81. Thus the total caesarean section rate (11.3%) was estimated to be reduced by 0.4%. No immediate serious complications were associated with the procedure. Two cases of intra-uterine fetal death occurred 2 and 5 weeks, respectively, after successful, uncomplicated version to vertex presentation. No obvious connection with the external cephalic version could be demonstrated. The effectiveness of version as a routine procedure is less than expected from reports of prospective trials of external cephalic version carried out by a few investigators, but the results may realistically illustrate what is achieved in the long term.     

Controlled trial of external cephalic version

Summary. A prospective randomized, controlled trial involving 640 singleton breech presentations after 30 weeks gestation was conducted to assess the value of external cephalic version. In 310 patients external cephalic version was attempted; the other 330 patients in whom version was not attempted constituted a control group. There were three perinatal deaths directly attributable to external cephalic version. No significant differences were found between the study and control groups respecting the incidence of vaginal breech delivery, caesarean section rate, perinatal mortality and morbidity. Our results suggest that there is no place for external cephalic version before 36 weeks gestation.     

Controlled trial of external cephalic version

A prospective randomized, controlled trial involving 640 singleton breech presentations after 30 weeks gestation was conducted to assess the value of external cephalic version. In 310 patients external cephalic version was attempted; the other 330 patients in whom version was not attempted constituted a control group. There were three perinatal deaths directly attributable to external cephalic version. No significant differences were found between the study and control groups respecting the incidence of vaginal breech delivery, caesarean section rate, perinatal mortality and morbidity. Our results suggest that there is no place for external cephalic version before 36 weeks gestation.     

External cephalic version with epidural anaesthesia after failure of a first trial with beta-mimetics

Objective To assess the efficacy, tolerance, and cost of external version under epidural anaesthesia and beta-mimetic tocolysis after the failure of an initial attempt with tocolysis alone.
Design Prospective open study.
Participants Sixty-eight women with breech presentation at around 36 weeks of gestation and an attempted external cephalic version under salbutamol that failed, who consented to try a second attempt under epidural anaesthesia.
Results The overall success rate under epidural anaesthesia was 39.7% (27/68), and complications occurred in two cases. The total cost of attempting external version was higher than the cost of expectant management.
Conclusions The efficacy of external cephalic version under epidural reduces the rate of caesarean sections associated with breech presentation, but its relative safety remains in question. Moreover, our economic analysis discourages the hope of lowered costs suggested by earlier reports that this technique is more expensive than expectant management, except in institutions with a policy of systematic caesarean sections when version fails.