둔위분만 (Breech delivery) - 의학 (Medicine)

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====== 둔위분만 (Breech delivery) ======
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둔위 (Breech presentation) 3–4% of all term pregnancies

국제 다기관 연구의 결과에 따라, 둔위인 태아의 계획된 둔위질식분만은 더이상 적절한 행위가 아님을 결론내렸다. 
둔위 질식 분만을 시도하지 말고, 가능하다면, 역아외회전술을 시도하고, 막달(term)에 지속적으로 둔위인 경우 계획된 제왕절개술을 시행할 것을 권고함. (([[https://www.ncbi.nlm.nih.gov/pubmed/12053896|ACOG committee opinion. Mode of term singleton breech delivery. 2001]]))

(([[http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14465/epdf]]))
=====역아 외회전술 (External Cephalic Version)=====

====방법====
 Cases of breech presentation < 34 weeks and > 40 weeks period of gestation, breech in labour, multiple gestation, severe oligohydramniosor polyhydramnios (amniotic fluid index [AFI] < 5 or > 25), cases with any contraindication to vaginal delivery, intra-uterine growth restriction, foetal anomalies and uterine malformations, cases with concomitant adverse factors like hypertensive disorders, diabetes mellitus or gestational diabetes mellitus, heart disease, previous caesarean delivery, and placenta previa or abruption placenta have been be excluded from the study. External cephalic version was carried out in selected cases after applying inclusion and exclusion criteria at or after 37 weeks of gestation. An ultrasound examination was performed to confirm the breech position, determine the AFI, and note the placental location and rule out congenital anomalies and the presence of a nuchal cord. The patient was asked to empty her bladder. A non-stress test was performed to confirm the absence of foetal heart rate abnormalities. Tocolysis terbutaline in a dosage of 0.25 mg was administered subcutaneously. The patient was placed in a slight Trendelenburg position to facilitate disengagement/mobility of the breech. After the procedure (regardless of success or failure), a non-stress test and ultrasound examination are performed to exclude foetal bradycardia and to confirm successful version.

====성공률====

35 ~ 86%, 평균 58 %

60% 시술 성공, 50% 질식분만 성공.
====합병증====

전체 합병증 비율 약11% (제일병원 )
===시술 직후===

* 진통과 일시적인 태아심박변화(fetal bradycardia and late decelerations)
  * placental abruption  
  * uterine rupture 
  * fetomaternal haemorrhage. 
  * preterm labor
  * 태아사망(fetal compromise)
  * 모성사망(양수색전 등)

심각한 합병증의 확률은 낮으며 응급제왕절개술의 비율은 0.5% 혹은 그 이하.

심박변화가 있던 4명 중 1명은 응급상황으로 판단되어 제왕절개술을 하였으며, 신생아중환자실에 3일간 입원(( [[https://www.hindawi.com/journals/tswj/2014/860107/|Successful External Cephalic Version: Factors Predicting Vaginal Birth|]] Pei Shan Lim et al. 2014))

===분만시===
자연 두정위에 비해 제왕절개율은 2배, 산과적 합병증 (유도분만 비율, 도구분만 비율, 출혈, 양수태변착색, [[nuchal_cord]]도 더 많다. ((Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. de Hundt M, Velzel J, de Groot CJ, Mol BW, Kok M Obstet Gynecol. 2014;123(6):1327. ))

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