臀先露及肩先露者剖宫产时取胎的临床体会

目的：探讨臀先露及肩先露者剖宫产时取胎的方法,减少或避免新生儿股骨骨折和髋关节脱位的发生。方法以顺胎体滑出方向用力行臀牵引方法取胎。结果臀先露及肩先露剖宫产者436例中发生新生儿骨折者2例,发生率为0．46％。结论行臀牵引取胎时避免暴力,顺胎体滑出方向用力可减少新生儿股骨骨折及髋关节脱位的发生。     

Comparison of cesarean versus vaginal delivery of extremely preterm gestations in breech presentation: retrospective cohort study

Objective: As survival increases at earlier gestational ages, the optimal mode of delivery, especially in cases of breech presentation, is of increasing importance. The objective of this study was to compare outcomes of vaginal delivery (VD) and cesarean section (CS) births for infants in breech presentation at borderline viability.

Study design: A retrospective chart review of live breech births between 23?+?0 and 25?+?6 weeks gestation at a tertiary university center from 2003 to 2013 was conducted. Those delivered vaginally were compared with those delivered by CS. Stillbirths and deliveries where no resuscitation was intended were removed from the analysis. Variables were compared using a Student t-test (continuous), Mann–Whitney U test (categorical), or a Chi-squared test (count). Logistic regression analysis was performed to further evaluate the results. Results with p?Results: One hundred seventy-six births were included, 36 VD and 140 CS. Baseline characteristics were similar between groups. Gestational age at delivery was significantly higher in CS deliveries (24.9?±?0.6 versus 24.5?±?0.7, p?=?.0007). The rate of neonatal death (23.6% versus 44.4%, p?=?.0127) was significantly lower in those born by CS. All other neonatal outcomes including Apgar scores at one and 5?min, cord gases, birth weight, length of stay in NICU, incidence of respiratory complications, and incidence of high-grade IVH demonstrated no significant differences. Logistic regression suggested that male sex, lower birth weight, and earlier gestational age are significantly associated with neonatal mortality. Thirty percent of uterine incisions were of the classical, high transverse or inverted-T types. The estimated blood loss was significantly higher in CS births (706.6?±?226.4 versus 327.4?±?174.1?mL, p?Conclusion: CS delivery of breech infants at borderline viability had a protective effect on neonatal mortality compared to VD depending on the regression model utilized. Infant sex, birth weight, and gestational age also contribute significantly to neonatal mortality. A prospective study of planned method of delivery is recommended to further explore this finding.     

The relation of breech presentation at term to epilepsy in childhood

OBJECTIVE: To investigate the relation between breech at term and epilepsy in childhood, and identify risk factors for epilepsy in term breech infants. STUDY DESIGN: Register-based study of all (n = 7514) singleton term infants without malformations, born between 1980 and 1994 and hospitalised with epilepsy until year 1996. For each case delivered in breech presentation (n = 290), the two subsequent deliveries of non-malformed, singleton infants delivered in breech presentation at term at the same hospital were selected as controls (n = 580). RESULTS: Breech presentation was a risk factor for epilepsy (OR: 1.2 [95% CI: 1.1, 1.3]). Breech infants with epilepsy were more often small for gestational age (9.7%) than breech infants without epilepsy (4.7%). Vaginal delivery was associated with low Apgar score, but mode of delivery and low Apgar score were not related to epilepsy. CONCLUSION: The increased risk of epilepsy in term breech infants is not related to intrapartum events, but to growth restriction in pregnancy.     

Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term,a qualitative analysis in the Netherlands

Objectiveexternal cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of women eligible for ECV undergo an ECV attempt. The aim of the study was to identify barriers and facilitators for ECV among professionals and women with a breech presentation at term.Designqualitative study with semi-structured interviews.SettingDutch hospitals.Participantspregnant women with a breech presentation who had decided on ECV, and midwives and gynaecologists treating women with a breech presentation.Measurementson the basis of national guidelines and expert opinions, we developed topic lists to guide the interviews and discuss barriers and facilitators in order to decide on ECV (pregnant women) or advice on ECV (midwives and gynaecologists).Findingsamong pregnant women the main barriers were fear, the preference to have a planned caesarean section (CS), incomplete information and having witnessed birth complications within the family or among friends. The main facilitators were the wish for a home birth, the wish for a vaginal delivery and confidence of the safety of ECV. Among professionals the main barriers were a lack of knowledge to fully inform and counsel patients on ECV, and the inability to counsel women who preferred a primary CS. The main facilitator was an unambiguous policy on (counselling for) ECV within the region.Conclusionwe identified several barriers and facilitators possibly explaining the suboptimal implementation of ECV for breech presentation in the Netherlands.This knowledge should be taken into account in designing implementation strategies for ECV to improve the uptake of ECV by professionals and patients.     

剖宫产时极度胎头高浮转为臀位分娩术式探讨

目的：探讨极度胎头高浮行剖宫产，转为臀位分娩的疗效；方法：对73例极度胎头高浮孕妇行剖宫产时转为臀部分娩，观察手术时间，手术出血量、子宫切口口延裂情况及新生儿Apgar评分；结果：观察组从切开子宫肌层至胎儿娩出时间明显缩短，而手术出血量及子宫切口延裂差异无显著性。观察组窒息率7.89%，对照组28.57%，差异无显著性；结论：极度胎头高浮转为臀位助产手术式可行，值得推广。     

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial

OBJECTIVE: The purpose of this study was to determine whether planned cesarean delivery for the singleton fetus in breech presentation at term reduces the risk of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN: In selected centers in the Term Breech Trial, children were screened for abnormalities at > or =2 years of age with the Ages and Stages Questionnaire, followed by a neurodevelopmental assessment if the Ages and Stages Questionnaire score was abnormal. RESULTS: A total of 923 of 1159 children (79.6%) from 85 centers were followed to 2 years of age. The risk of death or neurodevelopmental delay was no different for the planned cesarean than for the planned vaginal birth groups (14 children [3.1%] vs 13 children [2.8%]; relative risk, 1.09; 95% CI, 0.52- 2.30; P = .85; risk difference, +0.3%; 95% CI, -1.9%, +2.4%). CONCLUSION: Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.     

Influence of breech presentation on the development of fetal arm posture

BACKGROUND: In previous research, an age-related developmental trend towards increasing arm flexion has been found for cephalic fetuses. AIM: To determine if the development of arm posture in breech fetuses is comparable to that of cephalic ones. SUBJECTS AND METHODS: Fetal arm posture was studied longitudinally by means of real-time ultrasound in 13 healthy breech and 10 healthy cephalic fetuses. Observations started from 33 weeks gestational age until birth and were performed weekly in the breech group and every 2 weeks in the cephalic group. RESULTS: No difference could be found in arm posture between the left and the right arm in either group. Both breech and cephalic fetuses showed a clear preference for flexion in elbow and finger joints at all studied ages. After 36 weeks gestational age, the breech group showed significantly less wrist flexion when compared to the cephalic group (p = 0.037). A clear preference for location of the fetal hands near the fetal head could be observed for both groups. CONCLUSIONS: As there is no evidence for an abnormal neuromotor development in healthy breech fetuses, the observed difference in wrist flexion is probably due to differences in intrauterine environment. Because of the preference for location of the hands in the vicinity of the fetal head, breech fetuses probably experience a less restricted environment (in the upper part of the uterus) than cephalic fetuses (in the lower part of the uterus).     

Caesarean for breech: a paradigm shift?

The year 2001 became 'the year of Caesarean for the breech' after the results of the Term Breech Trial were published in October 2000. The purpose of the current paper is a retrospective observational study identifying the increase in Caesarean section rates that occurred in Fairfield Hospital after the Term Breech Trial. Fairfield Hospital is a level 2 hospital in the south-western Sydney health area with 1800 deliveries per year.     

Management of breech presentation in areas with high prevalence of HIV infection.

OBJECTIVE: To provide recommendations for the management of breech presentation in areas of high prevalence of human immunodeficiency virus (HIV) infection. METHOD: Review of relevant literature. RESULTS: Studies show that elective cesarean section (CS) is safer than vaginal delivery for breech presentation, external cephalic version (ECV) at term increases the chance of vaginal cephalic delivery. Although there are no studies of the risk of mother-to-child transmission of HIV from ECV, indirect evidence suggests that any increased risk is likely to be very small. RECOMMENDATIONS: Where CS is available and safe, HIV-positive women, or women who might be at risk of HIV, with a fetus at term with breech presentation, should be offered elective CS to reduce the risks of both vaginal breech delivery and mother-to-child HIV infection. HIV-negative women can be offered ECV at term to try to avoid CS. Where women do not have access to a safe CS, or prefer vaginal delivery, the benefit for both mother and child of attempting ECV at term is likely to outweigh the theoretical, very small, risk of facilitating HIV transmission.     

The association of hypopituitarism with small pituitary,invisible pituitary stalk,type 1 Arnold-Chiari malformation,and syringomyelia in seven patients born in breech position: a further proof of birth injury theory on the pathogenesis of “idiopathic hypopituitarism”

We report seven cases of hypopituitarism all having a history of breech delivery, asphyxia at birth, and syringomyelia. A small pituitary gland was found on MRI or CT in six cases, invisible pituitary stalk on MRI in five cases, and type 1 Arnold-Chiari malformation in six cases. A constellation of these abnormalities are best explained by traction of brain and spinal cord of the subjects exerted during breech delivery and further support the primary role of birth trauma in the genesis of idiopathic hypopituitarism.