Analysis Of Factors Influencing The Success Of External Cephalic Version And Its Clinical Application

Objectives:To study the evaluation index before the implementation of External Cephalic Version,effect,delivery outcome and neonatal prognosis of single breech pregnancy,so as to provide scientific basis for the effectiveness and safety of ECV implementation.Methods:The pregnant women with single breech pregnancy who received ECV from March 1,2016 to January 1,2019 in obstetrics department of our hospital were prospectively analyzed.After informed consent,71 pregnant women who met the criteria for admission were treated with ECV in our hospital.Before the implementation of ECV,the age,parity and body mass index of the patients were collected.And then get their fetal status by ultrasound,such as amniotic fluid index,abdominal wall thickness of pregnant women,placenta attachment position,fetal hip position,number of umbilical cord circles around neck,whether or not the buttocks were exposed into the pelvis.The use of anesthesia and uterine contraction inhibitors and the success of ECV were also recorded.Neonatal weight,mode of delivery,amniotic fluid status,neonatal 5-minute Apgar score(AS)less than 7 and neonatal admission to NICU were recorded after delivery.Univariate and multivariate analysis of the correlation between observational factors and the success of ECV.Comparing the success rate of ECV with the delivery mode of pregnant women without ECV in hip position in the same period in our hospital.The incidence of amniotic fluid contamination,5 min AS<7 and NICU occupancy rate of newborns were compared with those of head delivery pregnant women in the same period in our hospital.Results:1.After observing and recording the data and statistical analysis,it was found that the abdominal wall thickness(P=0.010),AFI(P=0.007),placenta position(P=0.011),number of umbilical cord circles(P=0.049)and birth weight(P=0.010)of pregnant women were related to the success of ECV.2.After correlation analysis,AFI was positively correlated with the success of ECV(P=0.007);abdominal wall thickness was negatively correlated with the success of ECV(P=0.001);the number of umbilical cord circles was negatively correlated with the success of ECV(P=0.050);and fetal weight was negatively correlated with the success of ECV(P=0.011).3.Placenta attachment position(x 2=30.775,P=0.000),number of umbilical cord circles around neck(t=1.997,P=0.04),AFI(t=2.776,P=0.00)and neonatal weight(t=2.601,P=0.011)are independent factors affecting the success of ECV.There were significant differences in delivery outcomes between ECV group(n=71)and non-ECV group(n=415):vaginal spontaneous delivery rate(36.62%VS8.19%,χ2=30.162,P=0.000),cesarean section rate(63.38%VS91.81%,x 2=68.522,P=0.000).5.There was no significant difference in adverse neonatal outcomes between ECV implementation group(n=70)and first-trimester pregnant women(n=13328):amniotic fluid contamination rate(18.81%VS 16.39%,χ2=0.135,P=0.076),5-minute AS<7 incidence(0.0%VS3.98%,x 2=0.607,P=0.436),neonatal NICU occupancy rate(12.68%VS15.90%,x 2=2.251,P=0.134).Conclusions:ECV under B-type ultrasound monitoring is safe and effective,does not increase the adverse prognosis of newborns,and effectively reduces the cesarean section rate of breech pregnancy.