臀位分娩

对于＜37周臀位的处理方法在临床上尚无一致意见。适于臀位早产的最佳分娩方式尚未在临床试验中进行全面评估，且母儿早产相对风险尚不明确。在缺乏充分证据情况下，如37周前诊断臀位，应根据早产及其他临床情况决定处理及分娩方式。

实施ECV无孕周上限，应推荐给所有晚孕期妇女。 该操作应由有经验的医师完成，所在医院应有紧急剖宫产条件，且无禁忌证。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf[31]Rosman AN, Guijt A, Vlemmix F, et al. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand. 2013;92:137-142.http://www.ncbi.nlm.nih.gov/pubmed/22994660?tool=bestpractice.com

操作步骤包括，体外加压推动或触摸孕妇腹部，迫使胎儿翻转（顺时针或逆时针）至头位。[37]Hofmeyr GJ. Effect of external cephalic version in late pregnancy on breech presentation and caesarean section rate: a controlled trial. Br J Obstet Gynaecol. 1983;90:392-399.http://www.ncbi.nlm.nih.gov/pubmed/6342657?tool=bestpractice.com

禁忌证包括多胎妊娠、严重胎儿畸形、胎膜破裂、晚孕期大量阴道出血及其他剖宫产指征（前置胎盘、子宫畸形等）。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf相对禁忌证包括：胎盘早剥、重度子痫前期/HELLP综合征，及胎儿宫内窘迫迹象（胎心异常和/或异常多普勒血流信号）。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf[31]Rosman AN, Guijt A, Vlemmix F, et al. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand. 2013;92:137-142.http://www.ncbi.nlm.nih.gov/pubmed/22994660?tool=bestpractice.com

ECV前后均应行胎心监护和超声检查。

如ECV成功，应根据一般头位情况进行规律产检。证据 A降低非头位及剖宫产率：有质量好的证据表明ECV可降低非头位产（RR 0.46, 95% CI 0.31-0.66）及剖宫产率（RR 0.63, 95% CI 0.44-0.90），围产期死亡率无显著变化（RR 0.34, 95% CI 0.05-2.12）。[28]Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2015;(4):CD000083.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000083.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23076883?tool=bestpractice.com既往观察性研究结果提示不良结局罕见。[32]Nassar N, Roberts CL, Barratt A, et al. Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term. Paediatr Perinat Epidemiol. 2006;20:163-171.http://www.ncbi.nlm.nih.gov/pubmed/16466434?tool=bestpractice.com[33]Nassar N, Roberts CL, Cameron CA, et al. Outcomes of external cephalic version and breech presentation at term: an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004. Acta Obstet Gynecol Scand. 2006;85:1231-1238.http://www.ncbi.nlm.nih.gov/pubmed/17068683?tool=bestpractice.com[34]Ghidini A, Korker V. Fetal complication after external cephalic version at term: case report and literature review. J Matern Fetal Med. 1999;8:190-192.http://www.ncbi.nlm.nih.gov/pubmed/10406304?tool=bestpractice.com[35]Collins S, Ellaway P, Harrington D, et al. The complications of external cephalic version: results from 805 consecutive attempts. BJOG. 2007;114:636-638.http://www.ncbi.nlm.nih.gov/pubmed/17355270?tool=bestpractice.com[36]Grootscholten K, Kok M, Oei SG, et al. External cephalic version-related risks: a meta-analysis. Obstet Gynecol. 2008;112:1143-1151.http://www.ncbi.nlm.nih.gov/pubmed/18978117?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。一项评估成功 ECV 后分娩方式的系统评价发现，相比自发性头位妊娠的女性，该类女性实行剖宫产及阴道分娩中使用仪器帮助的风险增加。然而，ECV 后实行剖宫产的比例（即 47%）仍低于持续臀位女性的剖宫产率（即 85%）。在需要尝试三次治疗的情况下，仍认为 ECV 是防止有剖宫产需求的一种有效方法。[45]de Hundt M, Velzel J, de Groot CJ, et al. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014;123:1327-1334.http://www.ncbi.nlm.nih.gov/pubmed/24807332?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

宫缩抑制剂包括肾上腺β-2受体激动剂，如沙丁胺醇、特布他林、利托君（在一些国家广泛应用于ECV，然而在美国尚未上市）。该类药物用于延后或抑制临产，提高ECV成功率。目前无临床证据推荐使用某一种β-2受体激动剂。目前，推荐根据当地规范使用宫缩抑制剂。

FDA警告注射用特布他林不得超过48至72小时，或口服特布他林作为急性期或后续治疗以预防早产或延长治疗，并且有可能导致孕妇严重心脏事件发生及死亡。FDA: terbutaline: warnings against use for treatment of preterm labor该警告对于ECV时皮下应用特布他林是否适用仍不明确。然而，目前的研究均支持这一用法。欧洲药物管理局（European Medicines Agency，EMA）推荐仅在22至37周孕妇中使用注射用β受体激动剂，最长可至48小时。由于该药物可能造成母儿心血管不良事件，该药物应在专业医生指导下以及持续母儿监护下使用。作为产科用药，EMA不再推荐口服或直肠内给药。[44]European Medicines Agency. Restrictions on use of short-acting beta-agonists in obstetric indications - CMDh endorses PRAC recommendations. October 2013. http://www.ema.europa.eu/ema/ (last accessed 16 March 2016).http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/10/news_detail_001931.jsp&mid=WC0b01ac058004d5c1

一项系统评价指出目前无证据支持使用硝苯地平作为宫缩抑制剂。[72]Wilcox C, Nassar N, Roberts C. Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review. BJOG. 2011;118:423-428.http://www.ncbi.nlm.nih.gov/pubmed/21199292?tool=bestpractice.com

尚无足够证据可用来评估用以帮助 ECV 的其他干预措施，包括胎儿脊柱中线位置声音刺激、硬膜外或脊髓麻醉。[43]Cluver C, Gyte GM, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev. 2015;(2):CD000184.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000184.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25674710?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于未致敏的Rh阴性血型孕妇，应使用抗D免疫球蛋白。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

使用该药的适应征为预防Rh同种免疫，避免影响再次妊娠结局。

抗D免疫球蛋白需在ECV时给予，如分娩Rh阳性的婴儿，则产妇产后需再次注射。[73]Royal College of Obstetricians and Gynaecologists. The use of anti-D immunoglobulin for Rh prophylaxis. March 2011. Http://www.rcog.org.uk (last accessed 16 March 2016).http://www.rcog.org.uk/womens-health/clinical-guidance/use-anti-d-immunoglobulin-rh-prophylaxis-green-top-22

操作结束后尽早使用，应于72小时内应用。

剂量取决于药物品牌。具体剂量咨询专科医生。

针对经选择患者组全部患者的治疗推荐

分娩方式选择（剖宫产或臀位阴道分娩）应基于主治医师经验、医院政策、孕妇要求及有无其他并发症情况。在美国，大多数ECV失败、持续臀位将通过剖宫产分娩。

有证据表明，相比于臀位阴道分娩，39周及以上剖宫产术可显著降低围产期死亡率及新生儿并发症发生率 (RR 0.33, 95% CI 0.19-0.56)。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com证据 C新生儿并发症发病率：一项质量不好的证据指出，在提高5分钟Apgar评分，降低新生儿插管率，或降低早产儿颅内出血率方面，择期剖宫产（elective caesarean delivery）不比选择性剖宫产（selective caesarean delivery）更有效。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。尽管剖宫产对于胎儿更加安全，但相比阴道分娩，其会轻度增加母亲患严重急性并发症的发生率（RR 1.29，95% CI 1.03-1.61）及未来妊娠的长期风险。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com

有些医生会选择阴道分娩，尤其是当孕妇强烈要求，经产妇有高年资、有经验的医生在场，无阴道分娩的绝对禁忌（前置胎盘、胎儿窘迫），单臀或完全臀先露，及胎儿体重合适（2000至3800g）。[24]Royal College of Obstetricians and Gynaecologists. Management of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-no-20b-breech-presentation.pdf[70]Society of Obstetricians and Gynaecologists of Canada. SOGC clinical practice guideline: vaginal delivery of breech presentation. June 2009. http://www.sogc.org (last accessed 16 March 2016).http://sogc.org/wp-content/uploads/2013/01/gui226CPG0906.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/19824190?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于未致敏的Rh阴性血型孕妇，应使用抗D免疫球蛋白。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

使用该药的适应征为预防Rh同种免疫，避免影响再次妊娠结局。

如分娩前3周内规范使用抗D免疫球蛋白，则不需重复使用。然而Kleihauer-Betke或rosette试验可帮助除外较严重的母胎出血。[73]Royal College of Obstetricians and Gynaecologists. The use of anti-D immunoglobulin for Rh prophylaxis. March 2011. Http://www.rcog.org.uk (last accessed 16 March 2016).http://www.rcog.org.uk/womens-health/clinical-guidance/use-anti-d-immunoglobulin-rh-prophylaxis-green-top-22

分娩结束后尽早使用，应于72小时内应用。

剂量取决于药物品牌。具体剂量咨询专科医生。

有证据表明，相比于臀位阴道分娩，39周及以上剖宫产术可显著降低围产期死亡率及新生儿并发症发病率 (RR 0.33, 95% CI 0.19-0.56)。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com证据 C新生儿并发症发病率：一项质量不好的证据指出，在提高5分钟Apgar评分，降低新生儿插管率，或降低早产儿颅内出血率方面，择期剖宫产（elective caesarean delivery）不比选择性剖宫产（selective caesarean delivery）更有效。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。

尽管剖宫产对于胎儿更加安全，但其会轻度增加母亲严重急性并发症发生率（RR 1.29，95% CI 1.03-1.61）及未来妊娠的长期风险。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com

分娩过程应持续胎心监护。[24]Royal College of Obstetricians and Gynaecologists. Management of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-no-20b-breech-presentation.pdf[25]American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Mode of term singleton breech delivery (reaffirmed 2014). ACOG Committee Opinion No. 340. Obstet Gynecol. 2006;108:235-237.http://www.ncbi.nlm.nih.gov/pubmed/16816088?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于未致敏的Rh阴性血型孕妇，应使用抗D免疫球蛋白。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

使用该药的适应征为预防Rh同种免疫，避免影响再次妊娠结局。

如分娩前3周内规范使用抗D免疫球蛋白，则不需重复使用。然而Kleihauer-Betke或rosette试验可帮助除外较严重的母胎出血。[73]Royal College of Obstetricians and Gynaecologists. The use of anti-D immunoglobulin for Rh prophylaxis. March 2011. Http://www.rcog.org.uk (last accessed 16 March 2016).http://www.rcog.org.uk/womens-health/clinical-guidance/use-anti-d-immunoglobulin-rh-prophylaxis-green-top-22

操作结束后尽早使用，应于72小时内应用。

剂量取决于药物品牌。具体剂量咨询专科医生。

分娩方式选择（剖宫产或臀位阴道分娩）应基于主治医师经验、医院政策、孕妇要求及有无其他并发症情况。

在单臀或完全臀先露的经产妇中，如孕妇强烈要求，有高年资有经验的医生在场，胎儿体重合适（2000至3800g），无阴道分娩的绝对禁忌（前置胎盘、胎儿窘迫），阴道分娩仍是可以考虑的分娩方式。[24]Royal College of Obstetricians and Gynaecologists. Management of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-no-20b-breech-presentation.pdf[70]Society of Obstetricians and Gynaecologists of Canada. SOGC clinical practice guideline: vaginal delivery of breech presentation. June 2009. http://www.sogc.org (last accessed 16 March 2016).http://sogc.org/wp-content/uploads/2013/01/gui226CPG0906.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/19824190?tool=bestpractice.com

有证据表明，相比于臀位阴道分娩，39周及以上剖宫产术可显著降低围产期死亡率及新生儿并发症发病率 (RR 0.33, 95% CI 0.19-0.56)。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于未致敏的Rh阴性血型孕妇，应使用抗D免疫球蛋白。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

使用该药的适应征为预防Rh同种免疫，避免影响再次妊娠结局。

如分娩前3周内规范使用抗D免疫球蛋白，则不需重复使用。然而Kleihauer-Betke或rosette试验可帮助除外较严重的母胎出血。[73]Royal College of Obstetricians and Gynaecologists. The use of anti-D immunoglobulin for Rh prophylaxis. March 2011. Http://www.rcog.org.uk (last accessed 16 March 2016).http://www.rcog.org.uk/womens-health/clinical-guidance/use-anti-d-immunoglobulin-rh-prophylaxis-green-top-22

分娩结束后尽早使用，应于72小时内应用。

剂量取决于药物品牌。具体剂量咨询专科医生。

在臀位临产早期，胎膜未破时，ECV是可以采用的。

ECV无孕周上限。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

操作步骤包括体外加压推动或触摸孕妇腹部迫使胎儿翻转（顺时针或逆时针）至头位。[37]Hofmeyr GJ. Effect of external cephalic version in late pregnancy on breech presentation and caesarean section rate: a controlled trial. Br J Obstet Gynaecol. 1983;90:392-399.http://www.ncbi.nlm.nih.gov/pubmed/6342657?tool=bestpractice.com

禁忌证包括多胎妊娠、严重胎儿畸形、胎膜破裂、晚孕期大量阴道出血及其他剖宫产指征（前置胎盘、子宫畸形等）。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

相对禁忌证包括：胎盘早剥、重度子痫前期/HELLP综合征，及胎儿宫内窘迫迹象（胎心异常和/或异常多普勒信号）。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf[31]Rosman AN, Guijt A, Vlemmix F, et al. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand. 2013;92:137-142.http://www.ncbi.nlm.nih.gov/pubmed/22994660?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于未致敏的Rh阴性血型孕妇，应使用抗D免疫球蛋白。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

使用该药的适应征为预防Rh同种免疫，避免影响再次妊娠结局。

抗D免疫球蛋白需在ECV时使用，如分娩Rh阳性婴儿，则产妇产后需再次注射。[73]Royal College of Obstetricians and Gynaecologists. The use of anti-D immunoglobulin for Rh prophylaxis. March 2011. Http://www.rcog.org.uk (last accessed 16 March 2016).http://www.rcog.org.uk/womens-health/clinical-guidance/use-anti-d-immunoglobulin-rh-prophylaxis-green-top-22

操作结束后尽早使用，应于72小时内应用。

剂量取决于药物品牌。具体剂量咨询专科医生。

有证据表明，相比于臀位阴道分娩，39周及以上剖宫产术可显著降低围产期死亡率及新生儿并发症发病率 (RR 0.33, 95% CI 0.19-0.56)。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com证据 C新生儿并发症发病率：一项质量不好的证据指出，在提高5分钟Apgar评分，降低新生儿插管率，或降低早产儿颅内出血率方面，择期剖宫产（elective caesarean delivery）不比选择性剖宫产（selective caesarean delivery）更有效。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。尽管剖宫产对于胎儿更加安全，但相比阴道分娩，其会轻度增加母亲患严重急性并发症的发生率（RR 1.29，95% CI 1.03-1.61）及未来妊娠的长期风险。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com

临产时未诊断的臀位一般会导致临产后剖宫产，增加急诊剖宫产和与此相关的孕妇并发症风险增加，增加脐带脱垂和新生儿预后不良风险。[23]Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ. 2001;322:1089-1093.http://www.ncbi.nlm.nih.gov/pubmed/11337436?tool=bestpractice.com[48]van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol. 1997;74:1-6.http://www.ncbi.nlm.nih.gov/pubmed/9243191?tool=bestpractice.com[33]Nassar N, Roberts CL, Cameron CA, et al. Outcomes of external cephalic version and breech presentation at term: an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004. Acta Obstet Gynecol Scand. 2006;85:1231-1238.http://www.ncbi.nlm.nih.gov/pubmed/17068683?tool=bestpractice.com[66]Nwosu EC, Walkinshaw S, Chia P, et al. Undiagnosed breech. Br J Obstet Gynaecol. 1993;100:531-535.http://www.ncbi.nlm.nih.gov/pubmed/8334087?tool=bestpractice.com[67]Flamm BL, Ruffini RM. Undetected breech presentation: impact on external version and cesarean rates. Am J Perinatol. 1998;15:287-289.http://www.ncbi.nlm.nih.gov/pubmed/9643632?tool=bestpractice.com[68]Cockburn J, Foong C, Cockburn P. Undiagnosed breech. Br J Obstet Gynaecol. 1994;101:648-649.http://www.ncbi.nlm.nih.gov/pubmed/8043554?tool=bestpractice.com[69]Leung WC, Pun TC, Wong WM. Undiagnosed breech revisited. Br J Obstet Gynaecol. 1999;106:638-641.http://www.ncbi.nlm.nih.gov/pubmed/10428517?tool=bestpractice.com

分娩过程应持续胎心监护。[24]Royal College of Obstetricians and Gynaecologists. Management of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-no-20b-breech-presentation.pdf[25]American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Mode of term singleton breech delivery (reaffirmed 2014). ACOG Committee Opinion No. 340. Obstet Gynecol. 2006;108:235-237.http://www.ncbi.nlm.nih.gov/pubmed/16816088?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于未致敏的Rh阴性血型孕妇，应使用抗D免疫球蛋白。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

使用该药的适应征为预防Rh同种免疫，避免影响再次妊娠结局。

如分娩前3周内规范使用抗D免疫球蛋白，则不需重复使用。然而Kleihauer-Betke或rosette试验可帮助除外较严重的母胎出血。[73]Royal College of Obstetricians and Gynaecologists. The use of anti-D immunoglobulin for Rh prophylaxis. March 2011. Http://www.rcog.org.uk (last accessed 16 March 2016).http://www.rcog.org.uk/womens-health/clinical-guidance/use-anti-d-immunoglobulin-rh-prophylaxis-green-top-22

操作结束后尽早使用，应于72小时内应用。

剂量取决于药物品牌。具体剂量咨询专科医生。

分娩方式选择（剖宫产或臀位阴道分娩）应基于主治医师经验、医院政策、孕妇要求及有无其他并发症情况。

有些医生会选择阴道分娩，尤其是当孕妇强烈要求，经产妇有高年资有经验的医生在场，无阴道分娩的绝对禁忌（前置胎盘、胎儿窘迫）、单臀或完全臀先露，胎儿体重合适（2000至3800g）。[24]Royal College of Obstetricians and Gynaecologists. Management of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-no-20b-breech-presentation.pdf[70]Society of Obstetricians and Gynaecologists of Canada. SOGC clinical practice guideline: vaginal delivery of breech presentation. June 2009. http://www.sogc.org (last accessed 16 March 2016).http://sogc.org/wp-content/uploads/2013/01/gui226CPG0906.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/19824190?tool=bestpractice.com

有证据表明，相比于臀位阴道分娩，39周及以上剖宫产术可显著降低围产期死亡率及新生儿并发症发病率 (RR 0.33, 95% CI 0.19-0.56)。[29]Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;(7):CD000166.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000166.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12917886?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对于未致敏的Rh阴性血型孕妇，应使用抗D免疫球蛋白。[30]Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. December 2006. http://www.rcog.org.uk (last accessed 16 March 2016).https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

使用该药指征为预防Rh同种免疫，避免影响再次妊娠。

如分娩前3周内规范使用抗D免疫球蛋白，则不需重复使用。然而Kleihauer-Betke或rosette试验可帮助除外较严重的母胎出血。[73]Royal College of Obstetricians and Gynaecologists. The use of anti-D immunoglobulin for Rh prophylaxis. March 2011. Http://www.rcog.org.uk (last accessed 16 March 2016).http://www.rcog.org.uk/womens-health/clinical-guidance/use-anti-d-immunoglobulin-rh-prophylaxis-green-top-22

分娩后尽早使用，应于72小时内应用。

剂量取决于药物品牌。具体剂量咨询专科医生。