硬膜外麻醉下臀位外倒转术成功的影响因素

 目的 探讨硬膜外麻醉下足月臀位外倒转术的影响因素。方法 回顾性分析2015-01至2021-02在首都医科大学附属北京妇产医院产检的B超确诊为单胎臀位并自愿选择行臀位外倒转术的孕37~40周的368例孕妇的临床资料,按成功与否分为两组。两组均是硬膜外麻醉后在B超监护下行外倒转术。分析年龄、产次、手术孕周、孕前体重指数、宫缩抑制药、新生儿体重、胎盘位置、脐带绕颈、脐带长度、臀先露的类型对臀位外倒转术的影响。结果 (1)硬膜外麻醉下足月臀位外倒转术的成功率为41.30%(152/368),手术成功孕妇的阴道分娩率82.24%(125/152);(2)单因素分析显示,两组孕妇的年龄、孕周、孕前体重指数、脐带绕颈、脐带长度、臀先露的类型比较,差异无统计学意义;两组产次、宫缩抑制药的使用、新生儿体重、胎盘位置的差异具有统计学意义(P＜0.05)。多因素Logistic回归分析显示,经产(OR=2.485,95%CI:1.499~4.121)、新生儿体重≥3000 g(OR=4.335,95%CI:2.470~7.607)、使用宫缩抑制药(OR=8.183,95%CI:4.668~14.348)是臀位外倒转术成功的独立有利因素。结论 硬膜外麻醉下足月臀位胎儿外倒转术可降低剖宫产率,手术成功的独立有利因素包括产次、使用宫缩抑制药、新生儿体重。

Influencing factors of successful external cephalic version for breech presentation under epidural anesthesia

Objective To investigate the influencing factors of successful external cephalic version (ECV) for breech presentation at term under epidural anesthesia. Methods The clinical data on 368 cases of singleton pregnant women with breech presentation who had undergone ECV at 37-40 gestational weeks between January 2015 and February 2021 was analyzed retrospectively. According to the outcomes of ECV, these women were divided into the success group and failure group. Both groups received ECV under B-ultrasound monitoring after epidural anesthesia. The maternal age, parity, gestational weeks, maternal body mass index before pregnancy, use of drugs for tocolysis, neonatal weight, placenta positions, umbilical cord entanglement, lengths of umbilical cords, and types of breech presentation on ECV were compared between the two groups. Results (1)The success rate of ECV was 41.30%(152/368), and the vaginal delivery rate in the success group was 82.24%(125/152). (2) Univariate analysis showed that there was no significant difference in age, gestational weeks, maternal body mass indexes before pregnancy, umbilical cord entanglement, umbilical cord lengths, or types of breech presentation between the two groups (P>0.05). However, there was significant difference in parity, use of tocolysis drugs, neonatal weight and placenta positions between the two groups (P<0.05). Multivariate logistic regression analysis suggested that multiparity (OR=2.485, 95%CI 1.499-4.121), neonatal weight ≥3000 g (OR=4.335, 95%CI 2.470-7.607), use of of tocolysis drugs (OR=8.183,95%CI 4.668-14.348) were independent favorable factors for the success of ECV. Conclusions The application of ECV in pregnant women with breech presentation at term can reduce the rate of cesarean section significantly. The independent influencing factors that contribute to the success of ECV include multiparity, the use of tocolysis drugs, and neonatal weight.