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Yerrabelli RS, Lee C, Palsgaard PK, Lauinger AR, Abdelsalam O, Jennings V. Prediction Models for Successful External Cephalic Version: An Updated Systematic Review. Am J Perinatol 2024; 41:e3210-e3240. [PMID: 37967871 DOI: 10.1055/a-2211-4806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To review the decision aids currently available or being developed to predict a patient's odds that their external cephalic version (ECV) will be successful. STUDY DESIGN We searched PubMed/MEDLINE, Cochrane Central, and ClinicalTrials.gov from 2015 to 2022. Articles from a pre-2015 systematic review were also included. We selected English-language articles describing or evaluating models (prediction rules) designed to predict an outcome of ECV for an individual patient. Acceptable model outcomes included cephalic presentation after the ECV attempt and whether the ECV ultimately resulted in a vaginal delivery. Two authors independently performed article selection following PRISMA 2020 guidelines. Since 2015, 380 unique records underwent title and abstract screening, and 49 reports underwent full-text review. Ultimately, 17 new articles and 8 from the prior review were included. Of the 25 articles, 22 proposed one to two models each for a total of 25 models, while the remaining 3 articles validated prior models without proposing new ones. RESULTS Of the 17 new articles, 10 were low, 6 moderate, and 1 high risk of bias. Almost all articles were from Europe (11/25) or Asia (10/25); only one study in the last 20 years was from the United States. The models found had diverse presentations including score charts, decision trees (flowcharts), and equations. The majority (13/25) had no form of validation and only 5/25 reached external validation. Only the Newman-Peacock model (United States, 1993) was repeatedly externally validated (Pakistan, 2012 and Portugal, 2018). Most models (14/25) were published in the last 5 years. In general, newer models were designed more robustly, used larger sample sizes, and were more mathematically rigorous. Thus, although they await further validation, there is great potential for these models to be more predictive than the Newman-Peacock model. CONCLUSION Only the Newman-Peacock model is ready for regular clinical use. Many newer models are promising but require further validation. KEY POINTS · 25 ECV prediction models have been published; 14 were in the last 5 years.. · The Newman-Peacock model is currently the only one with sufficient validation for clinical use.. · Many newer models appear to perform better but await further validation..
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Affiliation(s)
- Rahul Sai Yerrabelli
- Carle Illinois College of Medicine, The University of Illinois at Urbana-Champaign, Champaign, Illinois
- Department of Obstetrics and Gynecology, Carle Foundation Hospital, Urbana, Illinois
- Department of Obstetrics and Gynecology, Reading Hospital, Reading, Pennsylvania
| | - Claire Lee
- Carle Illinois College of Medicine, The University of Illinois at Urbana-Champaign, Champaign, Illinois
- Department of Obstetrics and Gynecology, Carle Foundation Hospital, Urbana, Illinois
| | - Peggy K Palsgaard
- Carle Illinois College of Medicine, The University of Illinois at Urbana-Champaign, Champaign, Illinois
- Department of Obstetrics and Gynecology, Carle Foundation Hospital, Urbana, Illinois
| | - Alexa R Lauinger
- Carle Illinois College of Medicine, The University of Illinois at Urbana-Champaign, Champaign, Illinois
| | | | - Valerie Jennings
- Carle Illinois College of Medicine, The University of Illinois at Urbana-Champaign, Champaign, Illinois
- Department of Obstetrics and Gynecology, Carle Foundation Hospital, Urbana, Illinois
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Londero AP, Xholli A, Massarotti C, Fruscalzo A, Cagnacci A. Factors influencing the effect of external cephalic version: a retrospective nationwide cohort analysis. Arch Gynecol Obstet 2023; 308:1127-1137. [PMID: 36068364 PMCID: PMC10435405 DOI: 10.1007/s00404-022-06763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/19/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aims to assess the factors associated with the success and failure rate of the external cephalic version (ECV) in breech fetuses. Secondary outcomes were fetal presentation in labor and mode of delivery. METHODS This cross-sectional study examined the live birth certificates from 2003 through 2020 from US states and territories that implemented the 2003 revision. A total of 149,671 singleton pregnancies with information about ECV success or failure were included. The outcome was ECV success/failure, while the exposures were possible factors associated with the outcome. RESULTS The successful ECV procedures were 96,137 (64.23%). Among the successful ECV procedures, the prevalence of spontaneous vaginal delivery was 71.63%. Among the failed ECV procedures, 24.74% had a cephalic presentation at delivery, but 63.11% of these pregnancies were delivered by cesarean section. Nulliparity, female sex, low fetal weight centile, high pre-pregnancy BMI, high BMI at delivery, and high maternal weight gain during pregnancy were associated with an increased ECV failure (p < 0.001). African American, American Indian and Alaska Native race categories were significant protective factors against ECV failure (p < 0.001). Maternal age had a U-shape risk profile, whereas younger maternal age (< 25 years) and old maternal age (> 40 years) were significant protective factors against ECV failure (p < 0.001). CONCLUSIONS A high prevalence of successful ECV procedures and subsequent spontaneous vaginal delivery were found. The present results found nulliparity, maternal race, maternal age, female fetal sex, low fetal weight, and maternal anthropometric features correlated to ECV results. These findings can potentially improve the knowledge about the factors involved in ECV, allowing more informed counseling to the women undergoing this procedure.
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Affiliation(s)
- Ambrogio P Londero
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy.
| | - Anjeza Xholli
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | - Claudia Massarotti
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | - Arrigo Fruscalzo
- Clinic of Obstetrics and Gynecology, University Hospital of Fribourg, Fribourg, Switzerland
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
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Unno S, Ogawa K, Nukariya A, Umehara N, Sago H. Predictive factors for successful external cephalic version with regional anesthesia. J Obstet Gynaecol Res 2023; 49:1335-1340. [PMID: 36796109 DOI: 10.1111/jog.15615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
AIM We aimed to investigate predictive factors of successful external cephalic version (ECV) using regional anesthesia. METHODS In this retrospective study, we included women who underwent ECV at our center from 2010 to 2022. The procedure had been conducted using regional anesthesia and the administration of intravenous ritodrine hydrochloride. The primary outcome was the success of ECV, which was defined as the rotation from a non-cephalic to a cephalic presentation. Primary exposures were maternal demographic factors and ultrasound findings at ECV. To determine predictive factors, we conducted a logistic regression analysis. RESULTS Of 622 pregnant women who underwent ECV, missing data on any variables (n = 14) were excluded and the remaining 608 were analyzed. The success rate during the study period was 76.3%. Multiparous women had significantly higher success rates than primiparous women (adjusted odds ratio [OR]: 2.06 [95% confidence interval (CI): 1.31-3.25]). Women with a maximum vertical pocket (MVP) of <4 cm had significantly lower success rates than those with 4 cm < MVP ≤6 cm (OR: 0.56 [95% CI: 0.37-0.86]). The non-anterior placental location was associated with higher success rates than the anterior placental location (OR: 1.46 [95% CI: 1.00-2.17]). CONCLUSIONS Multiparity, MVP >4 cm, and non-anterior placental locations were associated with successful ECV. These three factors could be useful for patient selection for successful ECV.
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Affiliation(s)
- Saori Unno
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kohei Ogawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akinori Nukariya
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nagayoshi Umehara
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Engel O, Arnon S, Shechter Maor G, Schreiber H, Piura E, Markovitch O. The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020354. [PMID: 36832483 PMCID: PMC9955877 DOI: 10.3390/children10020354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. Following ECV, fetal well-being is assessed via a non-stress test (NST). An alternative option to identify signs of fetal compromise is via the Doppler indices of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). Inclusion criteria were an uncomplicated pregnancy with breech presentation at term. Doppler velocimetry of the UA, MCA and DV were performed up to 1 h before and up to 2 h after ECV. The study included 56 patients who underwent elective ECV with a success rate of 75%. After ECV, the UA S/D ratio, UA pulsatility index (PI) and UA resistance index (RI) were increased compared to before the ECV (p = 0.021, p = 0.042, and p = 0.022, respectively). There were no differences in the Doppler MCA and DV before or after ECV. All patients were discharged after the procedure. ECV is associated with changes in the UA Doppler indices that might reflect interference in placental perfusion. These changes are probably short-term and have no detrimental effects on the outcomes of uncomplicated pregnancies. ECV is safe; yet it is a stimulus or stress that can affect placental circulation. Therefore, careful case selection for ECV is important.
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Affiliation(s)
- Offra Engel
- Obstetrical & Gynecological Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shmuel Arnon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neonatology, Meir Medical Center, 4428163 Kfar Saba, Israel
- Correspondence:
| | - Gil Shechter Maor
- Obstetrical & Gynecological Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Department of Neonatology, Meir Medical Center, 4428163 Kfar Saba, Israel
- High Risk Pregnancy Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Hanoch Schreiber
- Obstetrical & Gynecological Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ettie Piura
- Obstetrical & Gynecological Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ofer Markovitch
- Obstetrical & Gynecological Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Le Bars S, Harendarczyk L, Mortier A, Riche VP, Arthuis C, Thubert T, Winer N, Dochez V. [Tocolysis during External Cephalic Version (ECV): A retrospective before/after study in a type III maternity hospital]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:585-590. [PMID: 35644371 DOI: 10.1016/j.gofs.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE On January 2020, the French College of Gynecologists and Obstetricians (CNGOF) issued new Clinical Practice Guidelines (CPG) "Breech Presentation". Since then, it is recommended to use a tocolytic agent to improve the success rate of External Cephalic Version (ECV). The aim of this study, one year after these CPG, is to compare ECV without (before CPG) and with (after CPG) tocolysis in a type III maternity hospital. We intend to assess its effects on immediate success rate of ECV and obstetrical and neonatal outcomes. MATERIALS AND METHODS This is a single-center retrospective study conducted in Nantes University Hospital. We collected patient characteristics, immediate success rate, and maternal and neonatal outcomes at delivery of all ECV over two periods: the first one during 2019 (before CPG) and the second one from June 2020 to June 2021 (after CPG). RESULTS We included 253 patients: 126 in the first period and 127 in the second period. Immediate success rate of ECV was significantly higher since the use of tocolysis: 38.6 % (period 2) vs 23.8 % (period 1) (P=0.011). However, there was not significant difference found for cephalic presentation at birth, mode of delivery or obstetrical and neonatal outcomes. CONCLUSION The immediate success rate is significantly improved with the widespread use of tocolysis during ECV, with no change in obstetrical and neonatal outcomes.
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Affiliation(s)
- S Le Bars
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France
| | - L Harendarczyk
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France
| | - A Mortier
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France
| | - V-P Riche
- Service evaluation economique et développement des produits de santé, département partenariats et innovation, direction de la recherche, CHU de Nantes, Nantes, France
| | - C Arthuis
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France; Centre d'investigation clinique CIC 1413, INSERM, CHU de Nantes, Nantes, France
| | - T Thubert
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France; Centre d'investigation clinique CIC 1413, INSERM, CHU de Nantes, Nantes, France; Nantes université, mouvement - interactions-performance - MIP, EA4334, Nantes, France
| | - N Winer
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France; Centre d'investigation clinique CIC 1413, INSERM, CHU de Nantes, Nantes, France
| | - V Dochez
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France; Centre d'investigation clinique CIC 1413, INSERM, CHU de Nantes, Nantes, France; Nantes université, mouvement - interactions-performance - MIP, EA4334, Nantes, France.
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Lin J, Liu W, Gu W, Zhou Y. A prospective study using an individualized nomogram to predict the success rate of external cephalic version. Sci Rep 2022; 12:11795. [PMID: 35821248 PMCID: PMC9276686 DOI: 10.1038/s41598-022-16112-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022] Open
Abstract
To establish a clinical-based nomogram for predicting the success rate of external cephalic version (ECV) through a prospective study. This was a single-center prospective study that collected eligible breech pregnant women. 152 participants were enrolled in the training cohort, who received ECV procedures performed by a single operator. We used the training cohort to establish regression equations and prediction models. These variables include maternal factors (age, operation gestational age, pre-pregnancy BMI (Body Mass Index), operation BMI, BMI increase, multipara), ultrasound factors (fetal weight estimation, amniotic fluid index, placental location, type of breech presentation, spinal position), and anesthesia. Univariate and multivariable analyses were used to screen the factors affecting the success of ECV. A nomogram scoring model was established based on these factors. And C-index, DCA (Decision Curve Analysis) and calibration curve, Hosmer-Lemeshow test was used to verify the prediction effect of the model. Finally, 33 participants were enrolled in the testing cohort who received ECV with an unrestricted operator. We used C-index, DCA (decision curve analysis), and Hosmer-Lemeshow to verify the application value of the prediction model. The calibration curves and ROC curves of both the training cohort and testing cohort are plotted for internal and external validation of the model. The ECV success rate of the training cohort was 62.5%. Univariate analysis showed that the predictors related to the success rate of ECV were age, BMI increase value, AFI (amniotic fluid index), breech type, placental location, spinal position, anesthesia, and multipara. The prediction thresholds of the corresponding indexes were calculated according to the Youden index. Multivariate logistic regression analysis showed that BMI increase ≥ 3.85 kg/m2, AFI ≥ 10.6 cm, anesthesia, multipara, and non-anterior placenta were independent predictors of ECV success. Through the internal and external validation, it is confirmed that the model has a good calibration and prediction ability. Our nomogram has a good ability to predict the success rate of ECV.
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Affiliation(s)
- Jing Lin
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Wei Liu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Wei Gu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Ye Zhou
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
- Shanghai Municipal Key Clinical Specialty, Shanghai, China.
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Youssef A, Brunelli E, Fiorentini M, Lenzi J, Pilu G, El-Balat A. Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:609-615. [PMID: 33847431 DOI: 10.1002/uog.23649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA). METHODS Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra- and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using Bland-Altman analysis. Student's t-test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements. RESULTS Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80-0.93) and 0.83 (95% CI, 0.71-0.90), respectively. The mean difference between measurements was 0.4° (95% CI, -1.4 to 2.2°) for intraobserver repeatability and -0.4° (95% CI, -2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9-15.1°) and 13.6° (95% CI, 9.9-17.3°) for intra- and interobserver repeatability, respectively. The lower limits of agreement were -11.2° (95% CI, -14.3 to -8.1°) and -14.4° (95% CI, -18.2 to -10.7°) for intra- and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra- or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- or interobserver reliability. CONCLUSIONS BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Fiorentini
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - A El-Balat
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
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A Multivariable Predictive Model for Success of External Cephalic Version. Obstet Gynecol 2021; 138:426-433. [PMID: 34352823 DOI: 10.1097/aog.0000000000004518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To create a prediction model for external cephalic version (ECV) success using objective patient characteristics. METHODS This retrospective study included pregnant individuals of at least 18 years of age with a nonanomalous, singleton gestation who underwent an ECV attempt between 2006 and 2016 at a single quaternary care hospital. Variables assessed included maternal age, height, weight, body mass index (BMI), parity, fetal sex, gestational age, estimated fetal weight, type of fetal malpresentation, placental location, and amniotic fluid volume. Univariable and multivariable logistic regression models were used to determine the association of patient characteristics with ECV success. Estimated odds ratios and corresponding 95% CIs were calculated for each variable, and backward elimination and bootstrapping were used to find a parsimonious model for ECV success with the highest discriminatory capacity (as determined by the area under the receiver operating characteristic curve [AUC]). This model was evaluated with a calibration curve across deciles of success. RESULTS A total of 1,138 individuals underwent an ECV attempt and were included in this analysis. The overall ECV success frequency was 40.6%. Factors significantly associated with ECV success were maternal age, parity, placental location, estimated fetal weight, and type of fetal malpresentation. A final model with BMI, parity, placental location, and type of fetal malpresentation had the highest AUC (0.667 [95% CI 0.634-0.701]), resulted in good calibration, and is represented by the following equation: 1/[1+e-x] where x=1.1726-0.0314 (BMI)-0.9299 (nulliparity)+1.0218 (transverse or oblique presentation at ECV)-0.5113 (anterior placenta). An interactive version of this equation was created and can be accessed at www.ecvcalculator.com. CONCLUSION A prediction model that estimates the probability of ECV success was created and internally validated. This model incorporates easily obtainable and objective patient factors known before ECV and may be used in decision making and patient counseling about ECV.
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Dong T, Chen X, Zhao B, Jiang Y, Chen Y, Lv M, Pu Y, Chen G, Xu J, Luo Q. Development of prediction models for successful external cephalic version and delivery outcome. Arch Gynecol Obstet 2021; 305:63-75. [PMID: 34128125 DOI: 10.1007/s00404-021-06115-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To develop prediction models for the chance of successful external cephalic version (ECV) and delivery outcome. STUDY DESIGN This is a single-center retrospective study including 350 pregnant women with a singleton non-cephalic pregnancy at or after 36 weeks of gestational age. We selected 22 factors for ECV prediction and 21 for delivery outcome after successful ECV prediction as candidate predictors. Multivariable logistic regression with a stepwise backward selection procedure was used to construct a prediction model for the chance of successful ECV and the other for the delivery outcome. The discrimination and calibration of the models were assessed and internal validation was done with bootstrapping. RESULTS ECV was successfully performed in 232 cases (66.3%) among 343 women. Eight predictive factors were identified to be associated with a successful ECV: Gestational week at ECV < 39 weeks, multiparous, BMI before pregnancy < 22 kg/m3, palpable fetal head, breech engagement, larger AFI, larger BPD and posterior placenta. This model showed good calibration and good discrimination (c-statistic = 0.82, 95% CI 0.76-0.88). Six predictive factors were identified to be associated with vaginal delivery after successful ECV: age < 35, multiparous, BMI before pregnancy < 22 kg/m3, anterior placenta, lateral placenta and none-front fetal spine position. This model showed fair discrimination (c-statistic = 0.79, 95% CI 0.72-0.85). However, its calibration was not so satisfactory especially when the predicted probability was low. CONCLUSION We validated a prediction model for ECV and delivery outcome, showing that the model's overall performance is good. This can be used in clinical practice after external validation.
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Affiliation(s)
- Tian Dong
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Xinjie Chen
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Baihui Zhao
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Ying Jiang
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Yuan Chen
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Min Lv
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Yuqun Pu
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Guangdi Chen
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian Xu
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China.
| | - Qiong Luo
- Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, China.
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Dahl CM, Zhang Y, Ong JX, Yeh C, Son M, Miller ES, Roy A, Grobman WA. Patient characteristics associated with complications of external cephalic version. Am J Obstet Gynecol MFM 2021; 3:100411. [PMID: 34058425 DOI: 10.1016/j.ajogmf.2021.100411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/25/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient characteristics associated with external cephalic version success are well documented; however, the association between patient characteristics and the likelihood of external cephalic version complications is poorly understood. OBJECTIVE This study aimed to assess the frequency of patient characteristics associated with complications that lead to unanticipated delivery during external cephalic version. STUDY DESIGN This retrospective study included pregnant women aged at least 18 years with singleton gestations who underwent an external cephalic version attempt between 2006 and 2016 at a single quaternary care center. External cephalic version complications were defined as persistent nonreassuring fetal status, placental abruption, labor, spontaneous rupture of membranes, and umbilical cord prolapse. Complications were only considered if they led to unanticipated induction or cesarean delivery within 24 hours of external cephalic version. Patient characteristics including maternal age, height, weight, body mass index, parity, fetal sex, gestational age, estimated fetal weight, the type of fetal malpresentation, and placental location were analyzed for their association with external cephalic version complications using univariable analysis and multivariable logistic regressions. RESULTS Among the 1138 patients included in this analysis, external cephalic version complications occurred in 6.7% (n=76). These complications (not mutually exclusive) included nonreassuring fetal status (4.8%, n=55), placental abruption (1.6%, n=18), labor (1.0%, n=11), spontaneous rupture of membranes (0.6%, n=7), and cord prolapse (0.1%, n=1). Neonatal outcomes for those with complications included intensive care unit admission (10.5%, n=8), 5-minute Apgar scores <5 (1.3%, n=1), cord arterial pH <7 (6.6%, n=5), head cooling (1.3%, n=1), and anemia (6.6%, n=5). There were no perinatal deaths. In multivariable analysis, higher body mass index (adjusted odds ratio, 0.90 per kg/m2; 95% confidence interval, 0.84-0.97) and estimated fetal weight (adjusted odds ratio, 0.998 per gram; 95% confidence interval 0.998-0.999) were associated with decreased likelihood of experiencing external cephalic version complications, whereas greater gestational age at procedure (adjusted odds ratio, 1.95 per week; 95% confidence interval, 1.4-2.7) and anterior placental location (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.7) were associated with increased likelihood of experiencing external cephalic version complications. CONCLUSION In this large series, complications that led to delivery during external cephalic version occurred in 6.7% patients and were associated with body mass index, estimated fetal weight, gestational age, and placental location.
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Affiliation(s)
- Carly M Dahl
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman); Feinberg School of Medicine, Northwestern University, Chicago, IL (Dr Dahl, Mr Zhang, and Ms Ong).
| | - Yue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, IL (Dr Dahl, Mr Zhang, and Ms Ong)
| | - Janice X Ong
- Feinberg School of Medicine, Northwestern University, Chicago, IL (Dr Dahl, Mr Zhang, and Ms Ong)
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (Ms Yeh)
| | - Moeun Son
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman); Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT (Dr Son)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman)
| | - Archana Roy
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman)
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL (Drs Dahl, Son, Miller, Roy, and Grobman)
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Cillard L, Verhaeghe C, Spiers A, Madzou S, Descamps P, Legendre G, Corroenne R. External cephalic version: Predictors for success. J Gynecol Obstet Hum Reprod 2021; 50:102165. [PMID: 34004364 DOI: 10.1016/j.jogoh.2021.102165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to identify the factors predictive of the success of external cephalic version (ECV). METHODS A single-centre retrospective observational study was performed in the maternity ward of the Angers University Hospital, France, between January 2010 and May 2020. The study included all patients (n = 613) for whom an ECV was performed for a breech or transverse foetus. The primary endpoint was measured by the success of the ECV, defined by the visualisation, using pelvic ultrasound, of the foetus in cephalic presentation immediately after the manoeuvre. Following to the ECV, the cohort was separated into two groups; ECV Success and ECV Failure. In order to determine the predictive factors of success, a logistic regression model was performed, including the parameters of: parity, foetal presentation during ECV, the side of the foetal back, placental location, type of operator and maternal age. The results are presented as (odds ratio [confidence intervals]; p-value). The significance threshold was defined by a p-value < 0.05. RESULTS The ECV success rate was 21.4% (131/613). The factors predictive of the success of ECV were: transverse foetal presentation (2.7 [1.3-5.6]; p<0.01); a senior physician operator (1.6 [1.2-2]; p<0.01); multiparity (1.6 [1.2-2]; p<0.01); non anterior placental localization (1.4 [1.1-2]; p<0.01). A number of attempts greater than 3 were significantly associated with reduced chances of success (0.3 [0.2-0.4]; p<0.01). CONCLUSION The study shows that transverse foetal presentation, a senior physician operator, multiparity, as well as a non-anterior placental location are factors predictive of the success of ECV. Knowledge of these factors can improve the information given to patients.
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Affiliation(s)
- Léa Cillard
- Department of Obstetrics & Gynecology, University Hospital of Angers, Angers, France
| | - Caroline Verhaeghe
- Department of Obstetrics & Gynecology, University Hospital of Angers, Angers, France
| | - Andrew Spiers
- Department of Obstetrics & Gynecology, University Hospital of Angers, Angers, France
| | - Sebastien Madzou
- Department of Obstetrics & Gynecology, University Hospital of Angers, Angers, France
| | - Philippe Descamps
- Department of Obstetrics & Gynecology, University Hospital of Angers, Angers, France
| | - Guillaume Legendre
- Department of Obstetrics & Gynecology, University Hospital of Angers, Angers, France
| | - Romain Corroenne
- Department of Obstetrics & Gynecology, University Hospital of Angers, Angers, France.
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Abstract
Objective This study aimed to investigate the success rate, complications, and success-related factors of external cephalic version (ECV) of singleton breech pregnancies after 37 gestational weeks without anesthesia. Methods We studied 40 singleton breech pregnancies in women who underwent ECV without anesthesia after 37 gestational weeks from October 2018 to March 2020. On the basis of success of ECV, the women were divided into two groups of the successful group and the failed group. Various factors were analyzed to determine those that affect the success of ECV. Results Of the 40 attempts of ECV, 24 (60.0%) were successful and 16 (40.0%) failed. With regard to success-related factors, parity was significantly different between the two groups, with more multiparous women in the successful group than in the failed group. However, none of the other factors were significantly different between the groups. Fetal outcome was good in all of the cases. Ultimately, 3 cesarean sections were performed in the successful group and 16 were performed in the failed group. Conclusions ECV of breech presentation after the 37th week of pregnancy without anesthesia is an effective and relatively safe alternative, and can effectively reduce the cesarean section rate.
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Affiliation(s)
- Zheng Zhi
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou, China
| | - Lin Xi
- Department of Chinese Medicine, Wenzhou People's Hospital, Wenzhou, China
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13
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Correia Costa S, Raposo MI, Machado AP, Ramalho C, Ayres-de-Campos D, Montenegro N. External cephalic version: Predictors of success and influence on caesarean rates. Eur J Obstet Gynecol Reprod Biol 2020; 256:211-214. [PMID: 33248375 DOI: 10.1016/j.ejogrb.2020.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the success rate of external cephalic version, predictive factors for success of this maneuver and to examine how it affects mode of delivery, pregnancy and neonatal outcome rates. STUDY DESIGN Retrospective cross-sectional study performed in a tertiary care university hospital between January 2002 and June 2018. A total of 324 ECVs were performed in 321 pregnancies. Maternal and ultrasound data, procedure-related factors, birth characteristics and neonatal data were collected. Absolute and relative frequencies were used for descriptive analysis and the chi-square test for comparative analysis. Odds ratios with 95 % confidence intervals were calculated. RESULTS The overall success rate of the procedure was 33,3%. Multiparity, transverse lie, unengaged breech presentation, low body mass index, soft uterus and palpable fetal head were independent risk factors for success. No statistically significant association was found with other variables. Routine use of ECV allowed a reduction in cesarean delivery rates for breech presentation, with no increase in maternal or neonatal morbidity. Operative delivery rates after successful ECV were similar to those of the general population. DISCUSSION AND CONCLUSION Despite a relatively low overall success rate, routine use of ECV can result in reduced cesarean delivery rates with similar perinatal outcomes. Conveyed information on the success rate of ECV can be adapted to individual patient characteristics.
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Affiliation(s)
- Susana Correia Costa
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - Maria Inês Raposo
- Department of Obstetrics and Gynecology, Hospital Divino Espírito Santo, Ponta Delgada, Azores, Portugal
| | - Ana Paula Machado
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Carla Ramalho
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal; Health Innovation and Investigation Institute, University of Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics, Centro Hospitalar Lisboa Norte, Portugal; Faculty of Medicine, University of Lisbon, Portugal
| | - Nuno Montenegro
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Savchenko J, Lindqvist PG, Wendel SB. External cephalic version for breech presentation: The guideline landscape and a quest for an optimal approach. Eur J Obstet Gynecol Reprod Biol 2020; 255:197-202. [PMID: 33147532 DOI: 10.1016/j.ejogrb.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to illuminate differences in guidelines for external cephalic version (ECV) for breech presentation at or near term and assess their impact on effectiveness of the procedure in order to improve policymaking. STUDY DESIGN Guidelines from all Swedish ECV providers (hospitals with labor wards, n = 44) were retrieved in 2019 and assessed for similarities and differences. The scoring system based on the identified differences in timing, contraindications and periprocedural care was created. The hospitals were subsequently classified into either restrictive or liberal with regard to ECV. This classification was verified by comparing selection of patients for ECV attempts between the two groups. Our main outcomes were ECV success rate and effectiveness in reducing the remaining breech births and breech cesarean sections. RESULTS Important differences in timing of ECV, contraindications, periprocedural care, and counselling after failed ECV attempt were found. Two thirds of the hospitals were considered liberal and one third restrictive with regard to ECV. ECV success rate was significantly higher in hospitals with a liberal attitude towards ECV compared with restrictive hospitals (54.0 % vs 50.5 %, p = 0.015). Liberal hospitals had a significantly lower proportion of remaining breech births (2.81 % vs 3.01 %, p = 0.009) and breech cesarean sections at or near term (2.49 % vs 2.72 %, p = 0.003). CONCLUSION Important differences in ECV guidelines were found. Hospitals with guidelines reflecting a liberal attitude to ECV had a higher ECV success rate, despite a less strict patient selection, and a lower proportion of breech births and breech cesarean sections, which is the aim of ECV. We recommend avoiding routine ill-founded restrictivity in ECV guidelines and support a more nuanced counselling.
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Affiliation(s)
- Julia Savchenko
- Department of Obstetrics and Gynecology, Stockholm South General Hospital (Södersjukhuset), Stockholm, Sweden; Department of Clinical Science and Education, Stockholm South General Hospital (Södersjukhuset), Karolinska Institutet, Stockholm, Sweden.
| | - Pelle G Lindqvist
- Department of Obstetrics and Gynecology, Stockholm South General Hospital (Södersjukhuset), Stockholm, Sweden; Department of Clinical Science and Education, Stockholm South General Hospital (Södersjukhuset), Karolinska Institutet, Stockholm, Sweden
| | - Sophia Brismar Wendel
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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15
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Tsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. Management of Breech Presentation: A Comparison of Four National Evidence-Based Guidelines. Am J Perinatol 2020; 37:1102-1109. [PMID: 31167240 DOI: 10.1055/s-0039-1692391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The management of breech presentation may improve perinatal outcomes. The aim of this study was to synthesize and compare published evidence of four national guidelines on breech presentation. STUDY DESIGN A descriptive review of four recently published national guidelines on breech presentation and external cephalic version (ECV) was conducted: Royal College of Obstetricians and Gynaecologists guideline on "External Cephalic Version and Reducing the Incidence of Term Breech Presentation" and "Management of Breech Presentation", American College of Obstetricians and Gynecologists guideline on "External Cephalic Version" and "Mode of Term Singleton Breech Delivery," Society of Obstetricians and Gynaecologists of Canada guideline on "Vaginal Delivery of Breech Presentation" and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists guideline on "Management of breech presentation at term." RESULTS Regarding ECV, there is no recommendation by the SOGC, whereas all other national guidelines recommend this technique. Regarding breech vaginal delivery, there are limited recommendations by the ACOG, whereas all other guidelines provide similar recommendations. The RANZCOG makes no special recommendations on the intrapartum period. CONCLUSION The differences among national guidelines point out the need for the adoption of an international consensus on the management of breech presentation.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
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16
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Mu XH, Shi HX, An R. Anesthesia efficacy of bupivacaine in pregnant participants with breech presentation receiving external cephalic version: A protocol of systematic review of randomized controlled trials. Medicine (Baltimore) 2020; 99:e20786. [PMID: 32569223 PMCID: PMC7310873 DOI: 10.1097/md.0000000000020786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of this study is to appraise the efficacy and safety of bupivacaine in pregnant participants with breech presentation (BP) receiving external cephalic version (ECV). METHODS The following electronic databases will be searched from the origin to the January 31, 2020: PUBMED, EMBASE, Cochrane Library, CINAHL, ACMD, PsycINFO, Scopus, OpenGrey, and China National Knowledge Infrastructure. No language and publication time limitations will be applied to all of them. Randomized controlled trials comparing bupivacaine to other interventions for pain relief in pregnant participants with BP undergoing ECV will be included in this study. Two authors will employ the selection of searched records, extraction of essential data from included RCTs, and risk of bias assessment for each eligible trail independently and respectively. Any doubts between 2 authors will be figured out by a third author through discussion. The risk of bias assessment will be judged using Cochrane risk of bias tool. The data pooling and analysis will be performed using RevMan 5.3 software. RESULTS This study will summarize the up-to-date high-quality evidence and will synthesis the outcome data from that evidence to explore the efficacy and safety of bupivacaine for pain relief in pregnant participants with BP undergoing ECV. CONCLUSION The findings of this study may present important guidance for patients, clinical practice, as well as health-policy makers regarding the utilization of bupivacaine for pain relief in pregnant participants with BP receiving ECV. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020164409.
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Affiliation(s)
- Xin-hua Mu
- Department of Anaesthesiology, The Affiliated Hospital of Inner Mongolia Medical University
| | - Hai-Xia Shi
- Department of Anaesthesiology, The Affiliated Hospital of Inner Mongolia Medical University
| | - Ran An
- Department of Emergency, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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17
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Abstract
OBJECTIVE To design a clinically based predictive model for the likelihood of successful external cephalic version (ECV). METHODS This single-center retrospective study was conducted from February 2016 to July 2018 and included all candidates for ECV between 36 and 41 weeks of gestation. Variables with a potential effect on ECV success were collected. These variables include: body mass index, amniotic fluid index, gestational age, parity, location of placenta, fetal trunk posture, time in breech presentation before the procedure and the ultrasonographically measured size of the amniotic fluid preceding the fetal presenting part (fore-bag). Variables' association with ECV success was evaluated using a multivariate logistic regression and a decision tree predicting ECV outcome was developed using 75% of the patients and validated on the remaining 25%. RESULTS Overall, 250 pregnant women were identified and opted for a trial of ECV by a single operator, with a success rate of 64.8%. Body mass index, size of fore-bag, and parity were independent determinants of the version success, whereas other variables had no statistically significant effect on the success rate. Our decision tree model divided the cohort into five subgroups according to various combinations of the three variables. When evaluated on the internal validation set, the C-Index of the tree was 0.933 (0.863-1) and the prediction accuracy was 91.9% (86.5%-97.3%). CONCLUSION A prediction model composed of three easily measurable variables enables accurate prediction of successful ECV at term. Fore-bag was identified as the most important discriminator. Our model holds in internal validation and it can be used to support patient counseling and decision making for ECV but should be externally validated.
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18
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Levin G, Rottenstreich A, Weill Y, Pollack RN. External cephalic version at term: A 6-year single-operator experience. Birth 2019; 46:616-622. [PMID: 30941816 DOI: 10.1111/birt.12429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND External cephalic version (ECV) should be offered for patients presenting with a noncephalic pregnancy that are willing to deliver vaginally. Various reports have evaluated predictors for successful ECV. Yet, none have reported a single-operator large cohort experience. We aim to analyze the outcome of referrals for ECV. METHODS We conducted a retrospective cohort study of prospectively collected data. We performed a multivariate analysis of data with respect to ECV procedures performed by a single operator in a 6-year period. Maternal and fetal characteristics were compared between ECV success and failure groups. RESULTS Six hundred and two women underwent ECV. Of them, ECV was successful in 432 (71.7%). A multivariate binary logistic regression model demonstrated that high liquor volume was a predictor of ECV success (Adj OR 1.17 [95% CI 1.09-1.26]). Failure of ECV was correlated with anterior placenta (0.44 [0.56-0.76]) and nulliparity (0.21 [0.11-0.36]). Adverse events were rare and mostly minor, occurring in 1% of procedures. CONCLUSIONS ECV has a high success rate and a low complication rate, enabling vaginal birth and avoiding cesarean. The role of manipulation of modifiable determinants such as liquor volume should be further assessed in future studies.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yishay Weill
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Raphael N Pollack
- Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel
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19
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Ducarme G. [Breech Presentation: CNGOF Guidelines for Clinical Practice - External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation]. ACTA ACUST UNITED AC 2019; 48:81-94. [PMID: 31678503 DOI: 10.1016/j.gofs.2019.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide guidelines regarding efficiency and safety of external cephalic version (ECV) attempt and alternatives methods to turn breech babies to cephalic presentation. METHODS MedLine and Cochrane Library databases search in French and English and review of the main foreign guidelines between 1980 and 2019. RESULTS ECV is associated with a decreasing rate of breech presentation at birth (LE2), and potentially with a lower rate of cesarean section (LE3) without an increase of severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV should be attempt (Professional consensus). ECV attempt should be performed with immediate access to an operating room for emergency cesarean (Professional consensus). The ECV attempt before 37 weeks, compared to ECV attempt after 37 weeks, increases the rate of cephalic presentation at birth (LE2) but with a small increase risk of moderate prematurity (LE2). ECV attempt should be performed from 36SA (Professional consensus). The main factors associated with successful ECV attempt are multiparity (LE3) and no maternal obesity (LE3). Parenteral tocolysis (β mimetic or atosiban), for ECV attempt at term is associated with a higher success rate (LE2), higher rate of achieved cephalic presentation in labor (LE2) and a lower cesarean section rate (LE2). It is recommended to use parenteral tocolysis for ECV attempt at term in order to increase its success rate (grade B). The ECV attempt is associated with an increase in transient FHR abnormalities (LE3), it is therefore recommended that cardiotocography should be performed prior and during 30minutes after the procedure (Professional consensus). There is no argument for recommending the practice of delayed cardiotocography after ECV attempt (Professional consensus). The risk of significant positivity (>30mL) of the Kleihauer test after ECV attempt is low (<0.1%) (LE3), it is not recommended to systematically perform a Kleihauer test after ECV attempt (professional consensus). In case of RH-1 negative women, it is recommended to ensure systematic RH-1 prophylaxis (Professional consensus). In case of breech presentation at term, acupuncture, moxibustion and postural methods are not effective in reducing breech presentation at birth (LE2), and are therefore not recommended (Grade B). CONCLUSION According to the clear benefits and the low risks of ECV attempt, all women with a breech presentation at term should be informed that ECV should be attempted to decrease breech presentation at birth and cesarean section.
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Affiliation(s)
- G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental, Les Oudairies, 85000 La Roche-sur-Yon, France.
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Reviving external cephalic version: a review of its efficacy, safety, and technical aspects. Obstet Gynecol Sci 2019; 62:371-381. [PMID: 31777732 PMCID: PMC6856475 DOI: 10.5468/ogs.2019.62.6.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 11/11/2022] Open
Abstract
Currently, the rate of cesarean sections being performed in Korea is approximately 40%, with Korea ranking 4th among the Organization for Economic Co-operation and Development countries with respect to cesarean deliveries. Breech presentation at term is an important indication for cesarean section among other factors, including medicolegal concerns and pregnancies in women of advanced maternal age. Term breech presentation is associated with a higher fetal mortality rate than that associated with a cephalic presentation. Therefore, in Korea, most of these women deliver by cesarean section to avoid the complications of vaginal breech delivery. However, cesarean section is itself associated with considerable obstetric morbidity and sometimes, mortality. External cephalic version (ECV) is a useful method to reduce the cesarean section rate in women with breech presentation and therefore to reduce the incidence of breech presentation at delivery. Studies have shown that routine use of ECV reduces the cesarean section rate by approximately two-thirds in term pregnancies with breech presentation. ECV is accepted as a safe, efficacious, and cost-effective method and is recommended by both the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists in all pregnancies with term breech presentation, if not contraindicated. In Korea, although most clinicians are aware of the option of ECV, their relative lack of experience in performing the procedure and fear of complications render them hesitant to perform ECV. This review is aimed at guiding obstetricians by describing the efficacy, safety concerns, and technical aspects of this procedure.
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Anand K, Keepanasseril A, Amala R, Nair NS. Development and validation of a clinical score to predict the probability of successful procedure in women undergoing external cephalic version. J Matern Fetal Neonatal Med 2019; 34:2925-2931. [PMID: 31590593 DOI: 10.1080/14767058.2019.1674803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION External Cephalic Version (ECV) reduces breech presentation at term and thus contribute to the reduction of cesarean section. This study was done to determine the factors associated with the successful ECV in women with breech presentation after 36 weeks' gestation and also to develop and validate a clinical score which could be utilized for individual patient counseling in future. METHODS This was a retrospective cohort study conducted in a tertiary care center and teaching hospital in south India. Prospectively collected data from the register maintained for all ECVs performed on pregnant women with breech presentation at or more than 36 weeks' gestation. Clinical and ultrasound parameters at the time of performing the procedure were used in the analysis. Multiple logistic regression with a stepwise backward selection procedure was used selecting potential variable to construct the model and internal validation was done with bootstrapping. Primary outcome was successful ECV defined as cephalic presentation at the end of the procedure. RESULTS Among 611 women who underwent ECV, it was successful in 70.4%. In the multiple logistic regression model, multiparity (OR4.48), AFI ≥ 7 (OR = 3.06), type of breech, posterior placental location (OR = 1.57), sacro-anterior position of breech (OR = 2.83), normal uterine tone (OR = 1.82) and fetal pole not engaged (OR = 2.82) were found to be predictive of successful ECV with good discrimination (AUC = 0.782) and acceptable calibration. Combining these factors from the model a predictive score (score 0-13) is proposed for clinical utility. CONCLUSIONS Combining clinical and ultrasound parameters into a predictive score, which is simple and effective, could be utilized in the clinical practice, once validated externally.
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Affiliation(s)
- Keerthana Anand
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Pondicherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Pondicherry, India
| | - R Amala
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - N Sreekumaran Nair
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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Rambow AC, Brügge M, Maass N, Farrokh A. Beckenendlage – Ist die vaginale Geburt out? DER GYNÄKOLOGE 2019. [DOI: 10.1007/s00129-019-4435-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nalam RL, Chinnachamy P, Emmanuel P. External Cephalic Version: A Dying Art Worth Reviving. J Obstet Gynaecol India 2018; 68:493-497. [PMID: 30416278 DOI: 10.1007/s13224-018-1090-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022] Open
Abstract
Purpose Breech presentation is the most common abnormal presentation occurring in 3-4% of all deliveries. Incidence of caesarean section for breech presentation has increased markedly in the last few decades. Attempting external cephalic version (ECV) reduces the chance of non-cephalic presentation at term, thus reducing the rate of caesarean sections. Methods Prospective study was conducted in secondary healthcare centre, in rural set-up from August 2013 to August 2015. A total of 52 patients were enrolled into the study. Results ECV was successful in 32 out of 52 patients with overall success of 61.5%. Out of the 32 successful ECVs, 24 patients delivered vaginally (75%) (p value 0.00), 6 patients delivered by caesarean section, and 2 patients were lost to follow-up. Transverse lie had 100% success rate for ECV (p value 0.005). Gravidity, placental position, gestational age and use of tocolytics did not influence the success rate of ECV. Most common problem observed during the procedure was abdominal discomfort. Conclusion ECV is a safe procedure with high percentage of patients delivering vaginally after successful version. Hence, acquiring skills in ECV should be considered mandatory in the postgraduate training of future obstetricians.
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Affiliation(s)
- Raj Lakshmi Nalam
- Department of Obstetrics and Gynaecology, RDT Hospital, Bathalapalli, Anantapur District, 515661 Andhra Pradesh India
| | - Priya Chinnachamy
- Department of Obstetrics and Gynaecology, Christian Fellowship Hospital, Oddanchatram, Tamil Nadu 624619 India
| | - Paul Emmanuel
- Department of Obstetrics and Gynaecology, Christian Fellowship Hospital, Oddanchatram, Tamil Nadu 624619 India
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Melo P, Georgiou EX, Hedditch A, Ellaway P, Impey L. External cephalic version at term: a cohort study of 18 years' experience. BJOG 2018; 126:493-499. [PMID: 30223309 DOI: 10.1111/1471-0528.15475] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 11/30/2022]
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 External cephalic version success rates, predictors of success and cephalic presentation at birth, and perinatal outcomes. RESULTS Three thousand eight 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 External cephalic version has a low complication rate and is effective for most breech presentations, enabling vaginal birth and avoiding caesarean section. TWEETABLE ABSTRACT External cephalic version can safely be performed with most breech presentations.
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Affiliation(s)
- P Melo
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - E X Georgiou
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A Hedditch
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - P Ellaway
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - L Impey
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Velzel J, Schuit E, Vlemmix F, Molkenboer JFM, Van der Post JAM, Mol BW, Kok M. Development and internal validation of a clinical prediction model for external cephalic version. Eur J Obstet Gynecol Reprod Biol 2018; 228:137-142. [PMID: 29940417 DOI: 10.1016/j.ejogrb.2018.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 06/10/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To develop a prediction model for the chance of successful external cephalic version (ECV). STUDY DESIGN This is a secondary analysis of a multicenter, open-label randomized controlled trial that assessed the effectiveness of atosiban compared to fenoterol as uterine relaxant during ECV in women with a singleton fetus in breech presentation with a gestational age of 36 weeks or more. Potential predictors included maternal, pregnancy, fetal, and treatment characteristics and were recorded in all participants. Multivariable logistic regression analysis with a stepwise backward selection procedure was used to construct a prediction model for the occurrence of successful ECV. Model performance was assessed using calibration and discrimination. RESULTS We included a total of 818 women with an overall ECV success rate of 37%. Ten predictive factors were identified with the stepwise selection procedure to be associated with a successful ECV: fenoterol as uterine relaxant, nulliparity, Caucasian ethnicity, gestational age at ECV, Amniotic Fluid Index, type of breech presentation, placental location, breech engagement, possibility to palpate the head and relaxation of the uterus. Our model showed good calibration and a good discriminative ability with a c-statistic of 0.78 (95% CI 0.75 to 0.81). CONCLUSION Prediction of success of ECV seems feasible with a model showing good performance. This can be used in clinical practice after external validation.
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Affiliation(s)
- Joost Velzel
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Ewoud Schuit
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floortje Vlemmix
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan F M Molkenboer
- Department of Obstetrics and Gynaecology, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Joris A M Van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton, Victoria, Australia
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
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Effect of Oral Hydration on External Cephalic Version at Term. J Obstet Gynecol Neonatal Nurs 2017; 46:686-695. [DOI: 10.1016/j.jogn.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 11/21/2022] Open
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Keepanasseril A, Anand K, Soundara Raghavan S. Matched cohort study of external cephalic version in women with previous cesarean delivery. Int J Gynaecol Obstet 2017; 138:79-83. [DOI: 10.1002/ijgo.12169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/19/2017] [Accepted: 04/03/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Keerthana Anand
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Subrahmanian Soundara Raghavan
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
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Wang ZH, Yang Y, Xu GP. Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e6256. [PMID: 28296735 PMCID: PMC5369890 DOI: 10.1097/md.0000000000006256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term. METHODS A total of 144 nulliparous women with singleton breech presentation were randomly divided into the intervention group and the placebo group, with 72 subjects in each group. The subjects in the intervention group received remifentanil (infused at 0.1 μg kg min with demand boluses of 0.1 μg/kg), whereas those in the placebo group were given saline placebo. This study was conducted from May 2013 to April 2016. The outcomes measures include pain (measured with the visual analog scale, VAS), success rate of ECV, maternal satisfaction for ECV, and adverse events. RESULTS A total of 137 participants completed the study. The intervention with remifentanil showed greater efficacy than did placebo in decreasing the VAS score immediately after ECV (intervention group 4.3 ± 2.2 vs placebo group 6.4 ± 2.5, P < 0.01). A significant difference in the ECV success rate was also found between the 2 groups (intervention group 56.9% vs placebo group 38.9%, P = 0.03). In addition, a significant difference in the satisfaction score was also detected (intervention group 9.3 ± 0.9 vs placebo group 6.7 ± 1.2, P < 0.01). The observed adverse events were similar between the 2 groups. CONCLUSION This study shows that remifentanil could decrease pain, improve the ECV success rate, and improve satisfaction in nulliparous women at term during the period of ECV. Furthermore, it is also well tolerated with few adverse events.
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Abstract
BACKGROUND Although external cephalic version (ECV) can be effective for correcting the fetus in a cephalic presentation, it may be painful for the mother. This study aimed to evaluate the efficacy and safety of remifentanil for pain relief during ECV in China. METHODS In all, 152 Chinese parturients with singleton breech presentation were randomly divided into 2 groups, each with 76 patients. All 152 patients were assigned to receive either remifentanil (infused at 0.1 μg/kg/min and demand boluses of 0.1 μg/kg) or saline placebo. The study was performed between January 2012 and December 2015. Outcome measurements included the Numerical Rating Pain Scale score (0-10) after ECV, success rate for ECV, and maternal satisfaction after ECV. Adverse events were also evaluated. RESULTS The study was completed by 146 patients. Remifentanil showed greater efficacy than placebo in decreasing the pain score immediately after ECV (remifentanil 4.6 ± 2.6 vs placebo 6.5 ± 2.7; P < 0.001). The success rate for ECV showed a significant difference between the 2 groups (remifentanil 56.5% vs placebo 39.5%; P = 0.04). Maternal satisfaction also showed a significant difference between the 2 groups (remifentanil 9.6 ± 1.4 vs placebo 6.4 ± 3.7; P < 0.001). However, the adverse events profiles were similar between both groups. CONCLUSION The results of this study demonstrate that remifentanil is an effective intervention for reducing pain, achieving successful ECV, and increasing maternal satisfaction during ECV, and is generally well-tolerated without additional adverse effects.
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Affiliation(s)
| | - Aiqin Xue
- Department of Obstetrics and Gynecology, The People's Hospital of Yan’an, Yan’an, China
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Basu A, Flatley C, Kumar S. Intrapartum intervention rates and perinatal outcomes following successful external cephalic version. J Perinatol 2016; 36:439-42. [PMID: 26796127 DOI: 10.1038/jp.2015.220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine intrapartum and perinatal outcomes following successful external cephalic version for breech presentation at term. STUDY DESIGN This was a retrospective cohort study of outcomes following successful external cephalic version in 411 women at an Australian tertiary maternity unit between November 2008 and March 2015. The study cohort was compared with a control group of 1236 women with cephalic presentation who underwent spontaneous labor. Intrapartum intervention rates and adverse neonatal outcomes were compared between both groups. RESULTS The success rate of external cephalic version (ECV) was 66.4%. The spontaneous vaginal delivery rate in the study cohort was 59.4% (224/411) vs 72.8% (900/1236) in the control cohort (P<0.001). Intrapartum intervention rates (emergency cesarean section (CS) and instrumental delivery) were higher in the ECV group (38% vs 27.2%, P<0.001). Rates of emergency CS for non-reassuring fetal status (9.5%, 39/411 vs 4.4%, 54/1236, P⩽0.001) and failure to progress (13.4%, 55/411 vs 4.1%, 51/1236, P<0.001) were higher in the study cohort. Neonatal outcomes were worse in the study cohort-Apgar score <7 at 5 min (2.2%, 9/411 vs 0.6%, 8/1236, P<0.001) and abnormal cord gases (8.5%, 35/411 vs 0.2%, 3/1236, P<0.001). Rates for resuscitation at birth and admission to the neonatal intensive care unit were higher in the study cohort (6.1% vs 4.1% and 1.9% vs 1.1%, respectively) but these were not statistically significant. CONCLUSION Labor following successful ECV is more likely to result in increased intrapartum intervention rates and poorer neonatal outcomes.
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Affiliation(s)
- A Basu
- Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
| | - C Flatley
- Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Dochez V, Delbos L, Esbelin J, Volteau C, Winer N, Sentilhes L. Facteurs prédictifs de réussite d’une version par manœuvre externe : étude bicentrique. ACTA ACUST UNITED AC 2016; 45:509-15. [DOI: 10.1016/j.jgyn.2015.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/28/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022]
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External cephalic version experiences in Korea. Obstet Gynecol Sci 2016; 59:85-90. [PMID: 27004197 PMCID: PMC4796091 DOI: 10.5468/ogs.2016.59.2.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/15/2015] [Accepted: 10/02/2015] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study was to evaluate obstetric outcomes of external cephalic version (ECV) performed at or near term. Methods Single pregnant woman with breech presentation at or near term (n=145), who experienced ECV by one obstetrician from November 2009 to July 2014 in our institution were included in the study. Maternal baseline characteristic and fetal ultrasonographic variables were checked before the procedure. After ECV, the delivery outcomes of the women were gathered. Variables affecting the success or failure of ECV were evaluated. Results Success rate of ECV was 71.0% (n=103). Four variables (parity, amniotic fluid index, fetal spine position and rotational direction) were observed to be in correlation with success or failure of ECV. In contactable 83 individuals experienced successful ECV, cesarean delivery rates were 18.1%, 28.9%, and 5.3% in total, nulliparas, and multiparas, respectively. Conclusion Based on the results, ECV is proposed to be safe for both mother and her fetus. In addition, it is a valuable procedure that increases probability of vaginal delivery for women with breech presentation.
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Abstract
Fetal malpresentation is an important cause of the high cesarean delivery rate in the United States and around the world. This includes breech, face, brow, and compound presentations as well as transverse lie. Risk factors include multiparity, previously affected pregnancy, polyhydramnios, and fetal and uterine anomalies. Appropriate management can reduce the need for cesarean delivery in some cases. This review discusses management options and focuses specifically on external cephalic version and vaginal breech delivery.
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Velzel J, de Hundt M, Mulder FM, Molkenboer JF, Van der Post JA, Mol BW, Kok M. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 195:160-167. [DOI: 10.1016/j.ejogrb.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/29/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Ebner F, Friedl TWP, Leinert E, Schramm A, Reister F, Lato K, Janni W, DeGregorio N. Predictors for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet 2015; 293:749-55. [DOI: 10.1007/s00404-015-3902-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
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Hemelaar J, Lim LN, Impey LW. The Impact of an ECV Service is Limited by Antenatal Breech Detection: A Retrospective Cohort Study. Birth 2015; 42:165-72. [PMID: 25872703 DOI: 10.1111/birt.12162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND External cephalic version (ECV) reduces the chance of breech presentation at term birth and lowers the chance of a cesarean delivery. ECV services are now in place in many units in the United Kingdom but their effectiveness is unknown. The aim of this study was to investigate the reasons for breech presentation at term birth. METHODS We performed a retrospective cohort study of 394 consecutive babies who were in breech presentation at term birth in a large United Kingdom maternity unit that offers ECV. The cohort was analyzed over two time periods 10 years apart: 1998-1999 and 2008-2009. RESULTS Only 33.8 percent of women had undergone a (failed) ECV attempt. This low proportion was mainly because breech presentation was not diagnosed antenatally (27.9%). Other contributing factors were: ECV not offered by clinicians (12.2%), ECV declined by women (14%), and contraindications to ECV (10.7%). Over the 10-year period, the proportion of breech presentations that were not diagnosed antenatally increased from 23.2 to 32.5 percent (p = 0.04), which constituted 52.8 percent of women who had not undergone an ECV attempt in 2008-2009. Failure of clinicians to offer ECV reduced from 21.6 to 3.0 percent (p = 0.0001) and the proportion of women declining ECV decreased from 19.1 to 9.0 percent (p = 0.005). Overall, ECV attempts increased from 28.9 to 38.5 percent (p = 0.05). CONCLUSIONS Although ECV counseling, referral, and attempt rates have increased, failure to detect breech presentation antenatally is the principal barrier to successful ECV. Improved breech detection would have a greater impact than methods to increase ECV success rates.
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Affiliation(s)
- Joris Hemelaar
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK.,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee N Lim
- Department of Obstetrics & Gynaecology, The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lawrence W Impey
- Fetal and Maternal Medicine, The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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van der Pol CB, McInnes MDF, Petrcich W, Tunis AS, Hanna R. Is quality and completeness of reporting of systematic reviews and meta-analyses published in high impact radiology journals associated with citation rates? PLoS One 2015; 10:e0119892. [PMID: 25775455 PMCID: PMC4361663 DOI: 10.1371/journal.pone.0119892] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/20/2015] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this study is to determine whether study quality and completeness of reporting of systematic reviews (SR) and meta-analyses (MA) published in high impact factor (IF) radiology journals is associated with citation rates. Methods All SR and MA published in English between Jan 2007–Dec 2011, in radiology journals with an IF >2.75, were identified on Ovid MEDLINE. The Assessing the Methodologic Quality of Systematic Reviews (AMSTAR) checklist for study quality, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for study completeness, was applied to each SR & MA. Each SR & MA was then searched in Google Scholar to yield a citation rate. Spearman correlation coefficients were used to assess the relationship between AMSTAR and PRISMA results with citation rate. Multivariate analyses were performed to account for the effect of journal IF and journal 5-year IF on correlation with citation rate. Values were reported as medians with interquartile range (IQR) provided. Results 129 studies from 11 journals were included (50 SR and 79 MA). Median AMSTAR result was 8.0/11 (IQR: 5–9) and median PRISMA result was 23.0/27 (IQR: 21–25). The median citation rate for SR & MA was 0.73 citations/month post-publication (IQR: 0.40–1.17). There was a positive correlation between both AMSTAR and PRISMA results and SR & MA citation rate; ρ=0.323 (P=0.0002) and ρ=0.327 (P=0.0002) respectively. Positive correlation persisted for AMSTAR and PRISMA results after journal IF was partialed out; ρ=0.243 (P=0.006) and ρ=0.256 (P=0.004), and after journal 5-year IF was partialed out; ρ=0.235 (P=0.008) and ρ=0.243 (P=0.006) respectively. Conclusion There is a positive correlation between the quality and the completeness of a reported SR or MA with citation rate which persists when adjusted for journal IF and journal 5-year IF.
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Affiliation(s)
| | - Matthew D. F. McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - William Petrcich
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adam S. Tunis
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramez Hanna
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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Schitter AM, Nedeljkovic M, Baur H, Fleckenstein J, Raio L. Effects of Passive Hydrotherapy WATSU (WaterShiatsu) in the Third Trimester of Pregnancy: Results of a Controlled Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:437650. [PMID: 25815033 PMCID: PMC4359846 DOI: 10.1155/2015/437650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/26/2014] [Accepted: 09/15/2014] [Indexed: 12/03/2022]
Abstract
Background. WATSU (WaterShiatsu) is a complementary therapeutic treatment method comprising passive stretches and massage techniques administered in 35°C warm water. Pregnant women claim safe methods to reduce pain, stress, and fatigue. Therefore, we conducted a pilot study evaluating the effects of WATSU on pregnancy-related complaints in third trimester pregnant women. Methods. Nine healthy pregnant women at gestational week ≥34 were included in an intervention group (receiving WATSU) and compared to eight women in a passive control group (receiving no treatment). WATSU was performed on days 1 and 4 of the study, accompanied by ultrasound examinations. Outcomes include physiological and psychometric as well as qualitative data. Participants in the control group completed questionnaires only. Results. WATSU was found to significantly lower participants' levels of stress and pain and to improve their mental health-related quality of life and mood. In comparison to the passive control group, participants in the intervention group reported reduction in perceived stress from day 1 to day 8 (P = 0.036, Cohen's f = 0.57). Qualitative data indicate that WATSU was appreciated as enjoyable and deeply relaxing. No negative side effects were reported. Conclusion. Our findings support the notion that WATSU yields therapeutic benefits for pregnant women and warrant further research. This study has been registered at ClinicalTrials.gov: NCT01708018.
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Affiliation(s)
- Agnes M. Schitter
- Department of TCM/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Imhoof-Pavillon, Inselspital, 3010 Bern, Switzerland
| | - Marko Nedeljkovic
- Department of TCM/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Imhoof-Pavillon, Inselspital, 3010 Bern, Switzerland
| | - Heiner Baur
- Department of Health, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Johannes Fleckenstein
- Department of TCM/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Imhoof-Pavillon, Inselspital, 3010 Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology Inselspital, University Hospital of Bern, Effingerstrasse 102, 3010 Bern, Switzerland
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Burgos J, Quintana E, Cobos P, Osuna C, Centeno MDM, Melchor JC. Effect of maternal intravenous fluid therapy on external cephalic version at term: a prospective cohort study. Am J Obstet Gynecol 2014; 211:665.e1-7. [PMID: 24949536 DOI: 10.1016/j.ajog.2014.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/07/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to analyze whether maternal intravenous fluid therapy prior to external cephalic version (ECV) increases the amount of amniotic fluid and the success rate of the procedure. STUDY DESIGN This was a prospective single-center cohort study of 200 women with a consecutive cohort of 100 pregnant women with a breech presentation at term who were administered intravenous fluid therapy with 2 L of hypotonic saline before the version attempt, compared to a control cohort of 100 pregnant women not given hydration treatment. RESULTS The mean increase in the amniotic fluid index (AFI) after intravenous maternal hydration was 3.75 ± 2.71 cm. The amount of fluid before hydration was the only variable found to be associated with increases in amniotic fluid levels, both in absolute and relative terms (odds ratio, -0.21; 95% confidence interval, -0.37 to -0.05 and odds ratio, -4.62; 95% confidence interval, -6.17 to -3.06; P < .01, respectively). We did not observe any severe complications secondary to the intravenous fluid therapy. The ECV success rate was 43% in the study group compared to 47% in the control group (P = .67). The success rate was significantly lower the larger the relative increase in the AFI, although no correlation was found in absolute terms (χ(2) for linear trend = 0.03 and 0.34, respectively). CONCLUSION Maternal intravenous fluid therapy with 2 L of hypotonic saline prior to ECV is an effective and safe technique for increasing the AFI. However, its use in ECV does not increase the success rate of the procedure.
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Affiliation(s)
- Jorge Burgos
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain.
| | - Eider Quintana
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain
| | - Patricia Cobos
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain
| | - Carmen Osuna
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain
| | - María del Mar Centeno
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain
| | - Juan Carlos Melchor
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain
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Salzer L, Nagar R, Melamed N, Wiznitzer A, Peled Y, Yogev Y. Predictors of successful external cephalic version and assessment of success for vaginal delivery. J Matern Fetal Neonatal Med 2014; 28:49-54. [DOI: 10.3109/14767058.2014.900749] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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43
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Fear for external cephalic version and depression: predictors of successful external cephalic version for breech presentation at term? BMC Pregnancy Childbirth 2014; 14:101. [PMID: 24620740 PMCID: PMC4007643 DOI: 10.1186/1471-2393-14-101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 12/24/2013] [Indexed: 11/29/2022] Open
Abstract
Background Objective was to determine whether fear for external cephalic version (ECV) and depression are associated with the success rate of ECV in women with a breech presentation at term. Methods Prospective study conducted in the Catharina Hospital Eindhoven between October 2007 and May 2012. Participants fulfilled The Edinburgh Depression Scale (EDS) questionnaire and expressed their degree of fear on a visual analogue scale from one to ten before ECV. Obstetric factors were evaluated as well. Primary outcome was the relation between psychological factors (fear for ECV and depression EDS scores) and ECV success rate. Secondary outcome was a possible relation between fear for ECV and increased abdominal muscle tension. Results The overall success rate was 55% and was significantly lower (p < 0.001) in nulliparous women (44.3%) compared with parous women (78.0%). Fear for ECV and depression EDS-scores were not related with ECV success rate. Parity, placental location, BMI and engagement of the fetal breech were obstetric factors associated with ECV outcome. There was no relation between fear for ECV and abdominal muscle tone. Conclusion Fear for ECV and depression were not related with ECV success rate in this study. Engagement of the fetal breech was the most important factor associated with a successful ECV. Trial registration EBIS: The Eindhoven Breech Intervention Study,
NCT00516555.
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Vallikkannu N, Nadzratulaiman WN, Omar SZ, Si Lay K, Tan PC. Talcum powder or aqueous gel to aid external cephalic version: a randomised controlled trial. BMC Pregnancy Childbirth 2014; 14:49. [PMID: 24468078 PMCID: PMC3932111 DOI: 10.1186/1471-2393-14-49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/27/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND External cephalic version (ECV) is offered to reduce the number of Caesarean delivery indicated by breech presentation which occurs in 3-4% of term pregnancies. ECV is commonly performed aided by the application of aqueous gel or talcum powder to the maternal abdomen. We sought to compare gel with powder during ECV on achieving successful version and increasing tolerability. METHOD We enrolled 95 women (≥ 36 weeks gestation) on their attendance for planned ECV. All participants received terbutaline tocolysis. Regional anaesthesia was not used. ECV was performed in the standard fashion after the application of the allocated aid. If the first round (maximum of 2 attempts) of ECV failed, crossover to the opposing aid was permitted. RESULTS 48 women were randomised to powder and 47 to gel. Self-reported procedure related median [interquartile range] pain scores (using a 10-point visual numerical rating scale VNRS; low score more pain) were 6 [5-9] vs. 8 [7-9] P = 0.03 in favor of gel. ECV was successful in 21/48 (43.8%) vs. 26/47 (55.3%) RR 0.6 95% CI 0.3-1.4 P = 0.3 for powder and gel arms respectively. Crossover to the opposing aid and a second round of ECV was performed in 13/27 (48.1%) following initial failure with powder and 4/21 (19%) after failure with gel (RR 3.9 95% CI 1.0-15 P = 0.07). ECV success rate was 5/13 (38.5%) vs. 1/4 (25%) P = 0.99 after crossover use of gel or powder respectively. Operators reported higher satisfaction score with the use of gel (high score, greater satisfaction) VNRS scores 6 [4.25-8] vs 8 [7-9] P = 0.01. CONCLUSION Women find gel use to be associated with less pain. The ECV success rate is not significantly different. TRIAL REGISTRATION The trial is registered with ISRCTN (identifier ISRCTN87231556).
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Affiliation(s)
- Narayanan Vallikkannu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
| | - Wan Nordin Nadzratulaiman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
| | - Khaing Si Lay
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
| | - Peng Chiong Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
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Tunis AS, McInnes MDF, Hanna R, Esmail K. Association of Study Quality with Completeness of Reporting: Have Completeness of Reporting and Quality of Systematic Reviews and Meta-Analyses in Major Radiology Journals Changed Since Publication of the PRISMA Statement? Radiology 2013; 269:413-26. [DOI: 10.1148/radiol.13130273] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Current obstetric practices: Are we on the right track? Int J Gynaecol Obstet 2013; 123:91-2. [PMID: 24028853 DOI: 10.1016/j.ijgo.2013.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Vlemmix F, Kuitert M, Bais J, Opmeer B, van der Post J, Mol BW, Kok M. Patient's willingness to opt for external cephalic version. J Psychosom Obstet Gynaecol 2013; 34:15-21. [PMID: 23394409 DOI: 10.3109/0167482x.2012.760540] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE External cephalic version (ECV) is a relatively simple and safe maneuver that reduces the cesarean section (CS) rate for breech presentation. There is professional consensus that ECV should be offered to all women, but only up to 70% of patients opt for this treatment. To improve counseling, we investigated the value patients place on various aspects of ECV. METHODS We studied patient preferences by means of a vignette study. Varying levels of treatment characteristics were investigated in 16 scenarios, all including the "opt out" alternative of an elective CS. The probability that women preferred ECV was estimated using a logistic regression approach. RESULTS Forty seven women participated in the study. Pain was the most important factor negatively influencing the willingness to opt for ECV (OR 0.11 (95% confidence interval (CI) 0.05-0.23) for a pain score of 8-10 compared to 1-2 on a visual analog scale of 0-10). Higher success rates of vaginal delivery after successful ECV increased women's willingness (OR 3.42 (95% CI 2.04-5.74), if chance of vaginal delivery after successful ECV increased from 24% to 52%). The risk of an emergency CS during ECV did not influence the willingness to opt for ECV (OR 0.83 (95% CI 0.59-1.18) of chance increased from 0% to 1%). CONCLUSIONS We conclude that expected pain during treatment and the success rate are the most important factors influencing the willingness to undergo ECV. Taking this information into account when counseling for ECV and reassuring women that unbearable pain is always a reason to stop ECV, and that the vast majority of women reported that the experienced pain is bearable, might improve the uptake of ECV and decrease the number of CS due to breech presentation.
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Affiliation(s)
- Floortje Vlemmix
- Department of Obstetrics and Gynecology, AMC, Amsterdam, the Netherlands.
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ROSMAN AGEETHN, GUIJT ALINE, VLEMMIX FLOORTJE, RIJNDERS MARLIES, MOL BENWJ, KOK MARJOLEIN. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand 2012; 92:137-42. [DOI: 10.1111/aogs.12011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Guerra S, Lopez-Picado A, Muñoz H, Marín J, Lete I, Echevarria O. Versión cefálica externa en presentación de nalgas: una técnica ancestral muy actual. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Suen SSH, Khaw KS, Wa Law L, Singh Sahota D, Yee Lee SW, Lau TK, Yeung Leung T. The force applied to successfully turn a foetus during reattempts of external cephalic version is substantially reduced when performed under spinal analgesia. J Matern Fetal Neonatal Med 2011; 25:719-22. [DOI: 10.3109/14767058.2011.589931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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