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

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External cephalic version at term: a cohort study of 18 years' experience.

Related Articles External cephalic version at term: a cohort study of 18 years' experience. BJOG. 2018 Sep 17;: Authors: Melo P, Georgiou EX, Hedditch A, Ellaway P, Impey L Abstract OBJECTIVE: To analyse the outcome of referrals for external cephalic version (ECV). DESIGN: Retrospective cohort study of prospectively collected data. SETTING: Major university hospital, UK. SAMPLE: Women with non-cephalic presentation at term and no prior caesarean, referred to a specialist clinic. METHODS: Details of referrals, ECV attempts and perinatal outcomes were prospectively collected and analysed. Multivariate binary logistic regression models were created to determine independent predictors of ECV success, reversion and spontaneous version. MAIN OUTCOME MEASURES: ECV success rates, predictors of success and cephalic presentation at birth, and perinatal outcomes. RESULTS: 3008 had confirmed breech presentation; 2614 women underwent ECV. Ineligibility for ECV occurred in 117 breech presentations (3.9%), and 297 eligible women (10.2%) declined it. ECV was successful in 1280 (49.0%, 95% CI 47.0-50.9%) (40% in nulliparous women; 64% in others); 1234 (97.3%) were cephalic at birth. Spontaneous version after failure occurred in 4.3%, and was more common in multiparas (aOR 2.47, 95% CI 1.43-4.26) and those with a posterior fetal back (aOR 6.09, 95% CI 1.90-19.53). Reversion after successful ECV occurred in 2.2%. In women with a successful ECV whose fetus remained cephalic at birth, 85.7% delivered vaginally. The corrected perinatal mortality of the ECV cohort was 0.12%.. CONCLUSION: ECV has a low complication rate, and is effective for most breech presentations, enabling vaginal birth and avoiding caesarean section. This article is protected by copyright. All rights reserved. PMID: 30223309 [PubMed - as supplied by publisher]