单胎臀位妊娠行外转胎位术的影响因素及妊娠结局分析

孟召然 李玲 范建辉 陈新娟 崔金晖

【摘要】 目的分析单胎臀位行外转胎位术的影响因素及妊娠结局。方法收集产检单胎臀位妊娠的102例患者临床资料，比较胎头外倒转成功者（成功组）与胎头外倒转失败者（失败组）产妇的年龄、外倒转孕周、孕前BMI、孕期BMI增加、产次、羊水深度、胎盘位置、脐带绕颈等危险因素，以及外转胎位术后妊娠结局（包括分娩的间隔、孕周、方式和新生儿pH值、黄疸、转儿科ICU、早产等差异。结果102例中，成功63例（61.8%），失败39例（38.2%），成功组与失败组患者的年龄、实施外转胎位术的孕周、孕前BMI、孕期BMI增加、产次、羊水深度、胎盘位置、脐带绕颈及新生儿体质量比较差异均无统计学意义（P均>0.05）。与失败组比较，成功组患者的分娩间隔和分娩孕周均较长、阴道顺产率较高（P均<0.05）。2组新生儿的pH值、黄疸和转科率比较差异均无统计学意义（P均>0.05）。结论 对单胎臀位妊娠实施外转胎位术，可增加阴道顺产率，降低剖宫产率。

【关键词】 外转胎位术;分娩;影响因素;妊娠结局

【Abstract】 Objective To analyze influencing factors and pregnancy outcomes of external cephalic version （ECV） for breech presentation in singleton pregnancies. Methods Clinical data of 102 cases of singleton pregnancy with breech presentation were retrospectively analyzed. All participants were divided into the success and failure groups. Risk factors including age，gestational week of ECV，BMI before and during pregnancy，times of delivery，amniotic fluid depth，placental position and umbilical cord around neck were analyzed. The pregnancy outcomes including delivery interval，gestational week，delivery pattern，neonatal pH，jaundice，transfer to pediatric ICU and premature delivery were statistically compared between two groups. ResultsAmong 102 cases，ECV was successfully performed in 63 （61.8%） and failed in 39 （38.2%）. Age，gestational week of ECV，BMI before and during pregnancy，times of delivery，amniotic fluid depth，placental position，umbilical cord around neck and birth weight did not significantly differ between two groups （all P>0.05）. The delivery interval and delivery week were significantly longer and the vaginal delivery rate was considerably higher in the success group compared with those in the failure group （all P<0.05）. No statistical significance was observed in the neonatal pH，jaundice and transfer to pediatric ICU between two groups （all P>0.05）. Conclusion To reduce the cesarean section rate and increase the vaginal delivery rate，ECV is recommended for breech presentation in singleton pregnancies.

【Key words】  External cephalic version;Delivery;Influencing factor;Pregnancy outcome

自然情況下，臀先露占妊娠足月分娩总数的3% ～ 4%[1]。臀位分娩的风险较头位分娩高，膝胸卧位、艾灸、针灸等方法纠正臀位的疗效缺乏高质量的循证医学证据证明[2]。外转胎位术是通过循证医学证实的纠正臀位有效方法，可以提高阴道分娩的成功率，降低剖宫产率[4]。随着二孩政策的开放，为降低剖宫产率，我科开展了外转胎位术，本研究回顾性分析我院单胎臀位外转胎位术的影响因素及妊娠结局，旨在为外转胎位术的临床应用提供参考。

对象与方法

一、研究对象

选择2015年9月至2017年12月在我院产检单胎臀位的102例患者。纳入……