[External cephalic version for breech presentation at term: an effective procedure to reduce the caesarean section rate].
Minerva Ginecol. 2003 Dec;55(6):519-24. PMID: 14676741
A Lojacono, G Donarini, A Valcamonico, M Soregaroli, T Frusca
Clinica Ostetrica e Ginecologica, Università degli Studi di Brescia, Brescia.
AIM: Although term breech presentation is a relatively rare condition (3-5% of all births), it continues to be an important indication for caesarean section and has contributed to its increased use. Risk of complications may be increased for both mother and foetus in such a situation. Vaginal delivery of a breech presenting foetus is complex and may involve many difficulties, so today there is a general consensus that planned caesarean section is better than planned vaginal birth for the foetus in breech presentation at term. External cephalic version is one of the most effective procedures in modern obstetrics. It involves the external manipulation of the foetus from the breech into the cephalic presentation. A successful manoeuvre can decrease costs by avoiding operative deliveries and decreasing maternal morbidity. The aim of the present study is to evaluate the effectiveness of this obstetric manoeuvre to increase the proportion of vertex presentation among foetuses that were formerly in the breech position near term, so as to reduce the caesarean section rate. The safety of the version is also showed. METHODS: From 1999 to 2002, 89 women with foetal breech presentation underwent external cephalic version at the Department of Obstetrics and Gynaecology of the Brescia University. The gestational age was 36.8+/-0.8 weeks. The following variables have been taken into consideration: breech variety, placental location, foetal back position, parity, amount of amniotic fluid and gestational age. Every attempt was performed with a prior use of an intravenous drip of Ritodrine, and foetal heart rate was monitored continuously with cardiotocogram. RESULTS: The success rate of the procedure was 42.7% (n=38). No maternal or foetal complication or side effects occurred, both during and after the manoeuvre, except a transient foetal bradycardia that resolved spontaneously. Only one spontaneous reversion of the foetus occurred before delivery. Of all the women that underwent a successful version, 84.2% (n=32) had a non complicated vaginal delivery. Five women (15.8%) had a caesarean section. There was no significant interaction between the variables assessed. CONCLUSION: The external cephalic version is a safe and effective manoeuvre reducing the risks of vaginal breech delivery and the rate of caesarean section.
Article Published Date : Dec 01, 2003
[External cephalic version as a possible treatment of breech presentation].
Minerva Ginecol. 2000 Jun;52(6):221-7. PMID: 11085044
M Giusti, G C Bertolotti, R E Nappi, A Fignon, C Zara
BACKGROUND: Breech presentation shows 3-4% incidence on every foetal presentation at the time of delivery and is more correlated than vertex presentation to a foetal risk of perinatal mortality (with a frequency from 2 to 5 times higher) and to foetal malformations, low weight at birth and prematurity. On the other hand, without a careful case selection, breech delivery has a higher risk of perinatal morbidity and mortality in comparison to cephalic presentation. It is estimated that perinatal mortality for breech presentation at term is about 4-5% for vaginal delivery and about 2-4% for caesarean section. In addition caesarean section has a higher maternal morbidity and a small but significant risk of perinatal mortality, therefore, external cephalic version (ECV) can be a good choice to increase physiological deliveries. The aim of the present study is to evaluate the real efficacy of this obstetric manoeuvre to decrease the frequency of breech presentation at delivery. METHODS: The study group included 67 patients (age 29.5 +/- 3.8) with foetal breech presentation at gestational age 35.8 +/- 1.9 weeks, recruited at the Department of Obstetrics and Gynaecology of the Pavia University. Every patient underwent ECV. The same physician has performed every ECV attempt using the forward roll technique, with previous tocolysis in 50 cases (rithodrine vs isoxsuprine). The following variables have been taken into consideration: amount of amniotic fluid, gestational age, kind of tocolysis, placental location, foetal back position, parity, breech variety and foetal adnexial complication at birth. RESULTS: ECV succeeded in 77.6% (n = 52) and failed in 22.4% (n = 15) of cases. No maternal or foetal complications, side effects and spontaneous breech version occurred and in 74.6% of cases (n = 50) a vaginal delivery was performed. In 25.4% of cases (n = 17) a caesarean section was performed (15 breech presentation, 1 foetal distress in labour and 1 cervical dystocia). Among variables examined related to successful ECV, it has been observed that the amount of amniotic fluid (chi 2 = 15.33; p<0.0000), the kind of tocolysis (chi 2 = 10.04; p<0.007) and the umbilical cord rounds (chi 2 = 3.98; p<0.045) were distributed in a significantly different way, whereas gestational age (p<0.045) was significantly higher in unsuccessful ECV. CONCLUSIONS: The results obtained suggest that ECV may be a good therapeutic approach for decreasing the percentage of breech presentation at delivery.
Article Published Date : Jun 01, 2000
Pregnancy Outcomes Of Consanguinity Among Antenatal Patients Attending Combined Military Hospital Quetta, Pakistan.
J Ayub Med Coll Abbottabad. 2018 Jul-Sep;30(3):423-427
Authors: Abrar S, Safdar W, Hanif M, Shujaat N
BACKGROUND: All definitions of consanguinity encompass the basic concept of close blood relation. Highest rates of consanguineous unions are observed for North and Sub Saharan Africa, Middle East, and west, central and south Asia, where 20-50% marriages are consanguineous. In Pakistan, we can hardly find any rigorous research on the pregnancy outcomes of consanguinity except those conducted by Allan Bittles. This study was conducted with the objective to measure statistically if there existed any association of consanguinity with pregnancy outcomes in the form of stillbirths, abortion and Rh-incompatibility.
METHODS: This cross sectional analytical study was conducted at the Obstetrics department of Combined Military Hospital Quetta, Pakistan from 1st November 2017 to 28th February 2018. All pregnant women visiting Out Patient Department were included. Women unwilling to participate or needing emergency intervention were excluded. Sample size, i.e., 384 was calculated using online OpenEpi calculator and simple random sampling technique was applied. A structured interviewer administered questionnaire was used to extract retrospective information. Descriptive statistics, 95% Confidence Intervals, Chi-Square test and Contingency Coefficient were calculated using SPSS Version 20. Results were regarded significant at p<0.05.
RESULTS: Out of 384 study participants, 188 (48.9% with 95% CI:43.9- 53.9%) were married to first cousins. Mean±SD age of the study participants was 27.5±4.8 years. Difference between stillbirth, and abortion among consanguineous unions and nonconsanguineous unions was significant while that of Rh-incompatibility was non-significant..
CONCLUSIONS: Large population based studies are needed before declaring consanguinity as a health problem in our setting.
PMID: 30465379 [PubMed - indexed for MEDLINE]