Cybermedlife - Therapeutic Actions External Cephalic Version

External cephalic version for breech presentation at term: an effective procedure to reduce the caesarean section rate

Abstract Title: [External cephalic version for breech presentation at term: an effective procedure to reduce the caesarean section rate]. Abstract Source: Minerva Ginecol. 2003 Dec;55(6):519-24. PMID: 14676741 Abstract Author(s): A Lojacono, G Donarini, A Valcamonico, M Soregaroli, T Frusca Article Affiliation: Clinica Ostetrica e Ginecologica, Università degli Studi di Brescia, Brescia. Abstract: 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

Abstract Title: [External cephalic version as a possible treatment of breech presentation]. Abstract Source: Minerva Ginecol. 2000 Jun;52(6):221-7. PMID: 11085044 Abstract Author(s): M Giusti, G C Bertolotti, R E Nappi, A Fignon, C Zara Article Affiliation: Clinica Ostetrica e Ginecologica, IRCCS Policlinico San Matteo, Università degli Studi, Pavia. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: 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
Therapeutic Actions External Cephalic Version

NCBI pubmed

Prevalence of Chlamydia trachomatis in Pregnant Iranian Women: A Systematic Review and Meta-Analysis.

Prevalence of Chlamydia trachomatis in Pregnant Iranian Women: A Systematic Review and Meta-Analysis. Int J Fertil Steril. 2018 Jun;12(3):191-199 Authors: Azami M, Badfar GH, Mansouri A, Yekta Kooshali MH, Kooti W, Tardeh Z, Soleymani A, Abbasalizadeh SH Abstract Several studies have been conducted regarding the prevalence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in pregnant Iranian women. However, it is necessary to combine the previous results to present a general assessment. We conducted the present study based on systematic review and meta-analysis studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the national and international online databases of MagIran, IranMedex, SID, MedLib, IranDoc, Scopus, PubMed, ISI Web of Knowledge, and Google Scholar search engine for certain MeSH keywords until June 16, 2017. In addition, heterogeneity, sensitivity analysis, subgroup analysis, and publication bias were performed. The data were analyzed using random-effects model and Comprehensive Meta-Analysis version 2 and P value was considered lower than 0.05. The prevalence of Chlamydia trachomatis in 11 surveyed articles that assessed 2864 pregnant Iranian women was 8.74% [95% confidence interval (CI): 5.40-13.84]. The prevalence of Chlamydia trachomatis was estimated 5.73% (95% CI: 2.09-14.73) and 13.55% (95% CI: 11.23-16.25) by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), respectively which the difference was not significant (P=0.082). The lowest and highest prevalence of Chlamydia trachomatis was estimated in Tehran province [4.96% (95% CI: 2.45-9.810)] and Ardabil province [28.60% (95% CI: 20.61-38.20)], respectively. This difference was statistically significant (P<0.001). Meta-regression for the prevalence of Chlamydia trachomatis based on year of the studies was significant with increasing slope (P=0.017). According to the systematic review, the prevalence of Mycoplasma hominis and Urea plasma urealyticum indicated 2 to 22.8% (from 4 articles) and 9.1 to 19.8% (from 3 articles), respectively. There was no evidence of publication bias (P value for Begg and Eggers' tests was 0.161 and 0.173, respectively). The prevalence of Chlamydia trachomatis is high among pregnant Iranian women. Screening pregnant women as part of preventive measures seem necessary considering the potential for maternal and fetal complications. PMID: 29935063 [PubMed]

Documentation of the partograph in assessing the progress of labour by health care providers in Malawi's South-West zone.

Related Articles Documentation of the partograph in assessing the progress of labour by health care providers in Malawi's South-West zone. Reprod Health. 2017 Oct 23;14(1):134 Authors: Mandiwa C, Zamawe C Abstract BACKGROUND: There is some evidence that appropriate use of partograph in monitoring the progress of labour could decrease delivery related complications. The documentation of parameters of partographs is however, poorly understood. The aim of the present study was to determine the extent to which health care workers are making use of the partograph in monitoring the progress of labour through checking the documentation of the parameters of the partographs. METHODS: A hospital-based descriptive study involving retrospective review of partographs for births that occurred in 2016 was conducted in Malawi's South-West zone. A total of 1070 partographs that were used to monitor labour in two public hospitals were reviewed to determine the documentation of the parameters of partographs and descriptive statistics were computed using statistical package for the social science software version 22.0. RESULTS: Of the total 1070 partographs reviewed, 58.6% (n = 627) of the partographs had no recording of maternal blood pressure and 65.3% (n = 699) of the partographs had no temperature documentation. Moulding was not recorded in 25.4% (n = 272) of the partographs, foetal heart rate was not recorded in 14.9% (n = 159) of the partographs and descent of the foetal head was not recorded in 12.0% (n = 128) of the partographs. CONCLUSION: There is poor documentation of vital parameters of the partographs. This suggests insufficient monitoring of the progress of labour, which may lead to adverse pregnancy outcomes. To improve the accurate documentation of parameters of the partograph, there is a need to understand the problem and provide tailor-made solutions to address them and ultimately improve pregnancy outcomes. In the meantime, in-service refresher courses on partograph use to health care workers need to be conducted regularly. Supportive supervision to obstetric care providers and regular partograph audit could also improve documentation. PMID: 29061189 [PubMed - indexed for MEDLINE]