国际妇产科学杂志

国际妇产科学杂志 ›› 2022, Vol. 49 ›› Issue (1): 87-90.doi: 10.12280/gjfckx.20210482

• 产科生理及产科疾病:综述 • 上一篇    下一篇

有剖宫产史孕妇的臀位/横位外倒转术的研究进展

刘乐南, 张国英, 晋柏△()   

  1. 210029 南京医科大学第一附属医院（江苏省人民医院）产科
  • 收稿日期:2021-05-21 出版日期:2022-02-15 发布日期:2022-03-02
  • 通讯作者: 晋柏 E-mail:jinbai1018@yeah.net
  • 基金资助:
    2017年度江苏省妇幼健康科研项目(F201704)

Research Progress of External Cephalic Version among Pregnant Women with History of Cesarean Delivery

LIU Le-nan, ZHANG Guo-ying, JIN Bai△()   

  1. Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
  • Received:2021-05-21 Published:2022-02-15 Online:2022-03-02
  • Contact: JIN Bai E-mail:jinbai1018@yeah.net

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摘要：

外倒转术（external cephalic version,ECV）是指操作者在孕妇腹部转动胎儿,使臀位或横位的胎儿转为头位,避免臀位或横位的胎儿阴道分娩发生母儿不良损害,并且降低剖宫产率的一项产科实用技术。ECV被认为是一种安全、有效的操作方法。近年来,国际上对既往曾有ECV禁忌证的孕妇,如剖宫产史,也逐步开始施行ECV。与无剖宫产史孕妇相比,有剖宫产史并不影响ECV的成功率,其母儿并发症（如胎心异常、阴道出血、胎膜早破、紧急剖宫产和新生儿的不良预后等）并没有增加。有剖宫产史孕妇ECV过程中子宫破裂和瘢痕裂开的风险并未明显增加。产次是ECV成功率的重要影响因素。大多数有剖宫产孕妇ECV成功后可以顺利阴道分娩,但是阴道分娩成功率低于没有剖宫产史孕妇。在今后的临床实践中,对臀位合并剖宫产史的孕妇需逐步谨慎开展ECV,提供更多阴道分娩机会,提高产科服务质量。

关键词: 倒转术,胎位, 剖宫产后阴道分娩, 臀先露, 胎位不正, 外倒转术

Abstract:

External cephalic version (ECV) is the manipulation of the fetus presented in breech or transverse position, through the maternal abdomen, to a cephalic presentation, so as to avoid the adverse outcome for the mother and child during vaginal delivery of the breech or transverse fetal position. ECV is a safe and effective procedure to reduce cesarean delivery rates. ECV has been gradually applied to pregnant women with contraindications of ECV, such as cesarean section. A history of cesarean section did not affect the success rate of ECV, compared with no history of cesarean section, maternal and neonatal complications such as abnormal fetal heart rate, vaginal bleeding, premature rupture of membranes, emergency cesarean section, and poor neonatal prognosis were not increased. A previous cesarean delivery may not increase the risk of scar dehiscence or rupture during ECV. Parity is an important factor affecting the success rate of ECV. The majority of women with a previous cesarean delivery will have a successful vaginal birth after a successful ECV, but the rate of vaginal delivery is lower than that of women without a previous cesarean delivery. To promote a vaginal delivery and improve the obstetrics quality, ECV can be offered carefully to women with a breech presentation and a previous cesarean delivery.

Key words: Version,fetal, Vaginal birth after cesarean, Breech presentation, Abnormal fetal positions, External cephalic version