足月单胎臀位外倒转术失败因素的多维度分析与临床策略优化OA

Objective:To investigate factors associated with failed ECV and propose clinical optimization strategies to improve success rates,enhance patient acceptance,and reduce cesarean section rates.Methods:A retrospective analysis was conducted on 134 pregnant women who underwent ECV between June 1,2022,and December 31,2025,at the Department of Obstetrics,Zhangzhou Affiliated Hospital of Fujian Medical University.Factors influencing ECV failure and procedural safety were evaluated,and optimization strategies were explored based on clinical practice.Results:Univariate analysis revealed significant differences between the failure and success groups in mean BMI,breech type,umbilical cord entanglement,fetal back position,mean operative time,and manipulation technique(P<0.05).Multivariate analy-sis identified operative time and manipulation technique as independent risk factors for ECV failure(P<0.05).ROC curve analysis showed that operative time strongly predicted ECV suc-cess(AUC=0.928,95%CI:0.886～0.969,P=0.001).The optimal cutoff time was 17.5 mi-nutes,with failure rates significantly higher in the>17.5minute group compared to the≤17.5 minute group(67.92%vs 2.47%,P<0.001).Conclusion:ECV failure is associated with fac-tors such as frank breech,footling breech,umbilical cord entanglement(≥1 loop),and anterior fetal back position.Preoperative ultrasound screening aids in case selection and reduces failure rates.Operative time is an independent predictor of ECV failure,and procedures should be com-pleted within 17.5 minutes to avoid multiple attempts and complications.