Objective

Uterine anomalies (UA) occur in up to 6.7% of women. Breech is eight times more likely to occur with UA which may not be diagnosed prior to pregnancy and may only be found in the third trimester with breech. The objective of the study is to assess the prevalence of both already known and newly sonographically diagnosed UA in breech from 36 weeks of gestation and its impact on external cephalic version (ECV), delivery options and perinatal outcomes.

Study Design

We recruited 469 women with breech at 36 weeks of gestation over a 2-year period at the Charité University Hospital, Berlin. Ultrasound examination was performed to rule out UA. Patients with known and newly ‘de novo’ diagnosed anomalies were identified and delivery options and perinatal outcomes analyzed.

Results

The ‘de novo’ diagnosis of UA at 36–37 weeks of pregnancy with breech was found to be significantly higher compared to the diagnosis prior to pregnancy with 4.5% vs 1.5% (p < 0.001 and odds ratio 4 with 95% confidence interval 2.12–7.69). Anomalies found included 53.6% bicornis unicollis, 39.3% subseptus, 3.6% unicornis and 3.6% didelphys. A trial of vaginal breech delivery was successful in 55.5% of cases when attempted. There were no successful ECVs.

Conclusion

Breech is a marker for uterine malformation. Diagnosis of UA with breech can be up to four times improved with focused ultrasound screening in pregnancy even from 36 weeks of gestation prior to ECV to identify missed anomalies. Timely diagnosis aids antenatal care and delivery planning. Importantly, definitive diagnosis and treatment can be planned postpartum to improve outcomes in future pregnancies. ECV plays a limited role in selected cases.

中文翻译：

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在外部头颅版本之前通过臀位超声发现未诊断的子宫异常 – 有机会仔细观察

客观的

高达 6.7% 的女性患有子宫异常 (UA)。UA 发生臀位的可能性是 UA 的八倍，而 UA 可能在怀孕前无法诊断出来，只有在妊娠晚期才发现臀位。该研究的目的是评估妊娠 36 周以来已知的和新近超声诊断的臀位 UA 的患病率及其对头颅外翻 (ECV)、分娩选择和围产期结局的影响。

学习规划

我们在柏林夏里特大学医院招募了 469 名妊娠 36 周的臀位女性，历时两年。进行超声检查以排除 UA。确定已知和新诊断出异常的患者，并分析分娩选择和围产期结局。

结果

与孕前诊断相比，臀位妊娠 36-37 周时“从头”诊断 UA 的比例显着升高，分别为 4.5% 和 1.5%（p < 0.001，比值比 4，95% 置信区间为 2.12） –7.69）。发现的异常包括 53.6% 的双角畸形、39.3% 的隔下畸形、3.6% 的单角畸形和 3.6% 的双角畸形。阴道臀位分娩试验的成功率为 55.5%。没有成功的 ECV。

结论

臀位是子宫畸形的标志。通过妊娠期聚焦超声筛查（甚至从妊娠 36 周开始进行 ECV 之前），可以将臀位 UA 的诊断提高四倍，以识别遗漏的异常情况。及时诊断有助于产前护理和分娩计划。重要的是，可以在产后计划明确的诊断和治疗，以改善未来怀孕的结果。ECV 在某些情况下发挥的作用有限。