足月及近足月外倒转术的成功率及其影响因素分析  

Success rate and influencing factors of external cephalic version for singleton pregnancies in the third trimester

作　　者：龙俊青[1] 韦红卫[1] 夏红卫[1] 孔琳[1] 宋良[1] 杨钦灵[1] 覃钰芹 Long Junqing;Wei Hongwei;Xia Hongwei;Kong Lin;Song Liang;Yang Qinling;Qin Yuqin(Department of Obstetrics, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, China)

机构地区：[1]广西壮族自治区妇幼保健院产科,南宁530003

出　　处：《中华妇产科杂志》2019年第8期516-521,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨足月及近足月非头位行外倒转术(ECV)的成功率及影响ECV成功的因素。方法收集2016年1月至2018年6月在广西壮族自治区妇幼保健院进行ECV的358例妊娠36~40周、单胎、非头位孕妇的临床资料,分析ECV的成功率及其影响因素。结果(1)358例孕妇行ECV,其中251例成功,总ECV成功率为70.1%;其中经产妇的ECV成功率为79.1%(129/163),高于初产妇(62.6%,122/195),两者比较,差异有统计学意义(P<0.01);总自然分娩率为52.2%(187/358);其中经产妇的自然分娩率为61.3%(100/163),初产妇为44.6%(87/195),两者比较,差异有统计学意义(P<0.05)。(2)行ECV成功的251例孕妇的胎儿中,自行复转为臀位19例,复转率为7.6%;其中经产妇的复转率为10.9%(14/129),高于初产妇(4.1%,5/122),两者比较,差异有统计学意义(P<0.05)。(3)行ECV成功后未复转的232例孕妇中,187例自然分娩,自然分娩率为80.6%;其中经产妇的自然分娩率为87.0%(100/115),高于初产妇(74.4%,87/117),两者比较,差异有统计学意义(P<0.05)。(4)影响ECV成功的单因素分析显示,产次、胎先露的类型、胎先露是否入盆与ECV的成功率相关(P均<0.05)。ECV的总并发症的发生率为2.2%(8/358),其中胎儿窘迫、胎盘早剥和一过性胎心异常的发生率分别为0.6%(2/358)、0.3%(1/358)和1.4%(5/358)。结论选择合适的孕妇,在严密监护下实施ECV是有效的,值得临床推广应用。Objective To investigate the factors associated with the success rate of external cephalic version (ECV) for singleton and non-cephalic presentation pregnancies in the third trimester. Methods A retrospective study of ECV among singleton and non-cephalic presentation pregnant women in 36-40 weeks of gestation at Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2016 to June 2018 was analyzed. Results (1) Totally, 251 cases of 358 pregnant women who underwent ECV were successful, with a total success rate of 70.1%(251/358). The success rate of multipara was 79.1%(129/163), while 62.6%(122/195) in primipara (P<0.01). The total vaginal delivery rate was 52.2%(187/358), the vaginal delivery rate of multipara was 61.3%(100/163), while 44.6%(87/195) in primipara (P<0.01).(2) Spontaneous reversion occurred in 7.6%(19/251) of ECV successful women, the rate of reversion of multipara was 10.9%(14/129), higher than that of the primipara [4.1%(5/122);P<0.01].(3) Among the 232 pregnant women who did not reverted after successful ECV, 187 cases of successful vaginal delivery, the vaginal delivery rate was 80.6%(187/232);the vaginal delivery rate of the multipara was 87.0%(100/115), which was higher than that of the primipara [74.4%(87/117);P<0.01].(4) The variables significantly associated with ECV success were parity, type of breech, whether fetal presentation was in pelvic or not (all P<0.05). The complication rate was 2.2%(8/358), among which the incidence of fetal distress, placental abruption and transient fetal heart abnormalities were 0.6%(2/358), 0.3%(1/358) and 1.4%(5/358) respectively. Conclusion By close monitoring, ECV is a safe and effective procedure in selected appropriate cases, and worthy of clinical application.

关 键 词：倒转术 胎位 臀先露 影响因素分析 

分 类 号：R714.44[医药卫生—妇产科学]