Vaginal breech delivery in all-fours position-Hands off instead of intervention: A prospective observational study.

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2025-04-01 DOI:10.1111/aogs.15078

Gerhard Bogner, Johanna Schuller, Carina Gargitter, Eva Dölzlmüller, Thorsten Fischer, Claudius Fazelnia

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引用次数: 0

Abstract

Introduction: Vaginal delivery in cases of breech presentation is considered potentially stressful for the newborn. The maternal upright position may represent a more physiological approach to facilitating birth. We compare the safety and efficacy of two maternal positions in vaginal breech delivery.

Material and methods: A prospective, single-center, observational cohort study from October 2006 to January 2021 in a high-level obstetric center, in Salzburg, Austria. Vaginal breech deliveries in maternal all-fours position (n = 140) were compared with those in assisted supine position (n = 92). The primary outcome measures for neonatal morbidity included Apgar scores, pH levels, and the rate of transfer to the Neonatal Intensive Care Unit (NICU) postdelivery.

Results: In the all-fours position, 51.4% (n = 72) of deliveries occurred without obstetric intervention. The second stage of labor was significantly shorter in the supine position (39.5 min [95% CI 28-47] versus all fours position 52 min [95% CI 42-63], p = 0.042). Umbilical artery pH levels did not differ significantly (7.21 [95% CI 7.19-7.23] versus 7.19 [95% CI 7.17-7.21] vs. p = 0.06). Nor did the APGAR scores at 5 and 10 min below eight (p = 0.697; p = 0.760). Maternal and neonatal morbidity also did not significantly differ. Transfer of neonates to NICU n = 12 (13%) versus n = 11 (7.9%), p = 0.097, transfer birth-related n = 6 (6.5%) versus n = 8 (5.7%), p = 0.803. The number of postpartum umbilical artery pH < 7.10 were n = 9 (9.8%) versus n = 28 (20%), p = 0.065. There was one reported neonatal death due to intracerebral hemorrhage in the supine position group.

Conclusions: Our results indicate that vaginal breech delivery in the all-fours position seems to be comparable to supine position regarding neonatal safety. Additionally, the all-fours position shows potential for emergency management for unplanned breech deliveries by inexperienced attendants.

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四胎位阴道臀位分娩——双手放开而非干预：一项前瞻性观察研究。

简介：阴道分娩的情况下，臀位呈现被认为是新生儿潜在的压力。母亲的直立姿势可能代表了一种更生理的方式来促进分娩。我们比较两种产妇位在阴道臀位分娩的安全性和有效性。材料和方法：一项前瞻性、单中心、观察性队列研究，于2006年10月至2021年1月在奥地利萨尔茨堡的一家高级产科中心进行。产妇四足位阴道臀位分娩（n = 140）与辅助仰卧位分娩（n = 92）进行比较。新生儿发病率的主要结局指标包括Apgar评分、pH值和分娩后转至新生儿重症监护病房（NICU）的比率。结果：在四卧位中，51.4% （n = 72）的分娩没有产科干预。仰卧位第二产程明显缩短（39.5分钟[95% CI 28-47]，而四种体位均为52分钟[95% CI 42-63]， p = 0.042）。脐动脉pH值无显著差异（7.21 [95% CI 7.19-7.23] vs. 7.19 [95% CI 7.17-7.21] vs. p = 0.06）。5分钟和10分钟APGAR评分也未低于8分(p = 0.697；p = 0.760)。产妇和新生儿的发病率也没有显著差异。转新生儿NICU n = 12例（13%）vs n = 11例（7.9%），p = 0.097；转出生相关n = 6例（6.5%）vs n = 8例（5.7%），p = 0.803。结论：我们的研究结果表明，在新生儿安全性方面，四足位阴道臀位分娩似乎与仰卧位相当。此外，四脚朝天的姿势显示了对没有经验的助产士意外分娩的应急管理的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.