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Sánchez-Romero J, Gallego-Pozuelo RM, Dahmouni-Dahmouni H, Blanco-Carnero JE, Araico-Rodríguez F, Herrera-Giménez J, Guijarro-Campillo AR, Nieto-Díaz A, de Paco K. External cephalic version following prior cesarean delivery: A comparative cohort analysis. Int J Gynaecol Obstet 2024. [PMID: 38881234 DOI: 10.1002/ijgo.15738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To analyze the success rate of external cephalic version (ECV) in pregnant women with a history of previous cesarean section, as well as to describe the rate of complications associated with the procedure. METHODS A retrospective cohort study of women who were offered an ECV at "Virgen de la Arrixaca" Clinic University Hospital (Murcia, Spain) between January 2014 and December 2023. We collected data for previous cesarean delivery, obstetric history, fetal presentation, amniotic fluid volume, ECV success rate, complications related to ECV, mode of delivery, and neonatal outcomes. The study confidently performed ECV under sedation with propofol and tocolysis with ritodrine. Univariate and multivariate analyses were conducted to compare the success rate of ECV, ECV complications, and mode of delivery between women with and without previous cesarean sections. RESULTS Of 1116 pregnant women who were offered ECV, 911 were included in the study, with 42 having a previous cesarean section. The success rate of ECV in pregnant women with a previous cesarean section was 78.6% (adjusted odds ratio 1.18; 95% confidence interval 0.49-2.86; P = 0.708), with a low complication rate of 9.5%, such as non-reassuring fetal heart rate (7.1%) or major vaginal bleeding (2.4%). Of the women who attempted a vaginal delivery after ECV, 80.8% were successful. CONCLUSIONS These findings support that ECV is a safe and effective option for women with a previous cesarean section, with success rates comparable to those in women without a previous cesarean section.
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Affiliation(s)
- Javier Sánchez-Romero
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Rosa María Gallego-Pozuelo
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Hajar Dahmouni-Dahmouni
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - José Eliseo Blanco-Carnero
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Fernando Araico-Rodríguez
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | - Javier Herrera-Giménez
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | | | - Aníbal Nieto-Díaz
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Katy de Paco
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
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Carauleanu A, Tanasa IA, Nemescu D, Socolov D. Risk management of vaginal birth after cesarean section (Review). Exp Ther Med 2021; 22:1111. [PMID: 34504565 PMCID: PMC8383756 DOI: 10.3892/etm.2021.10545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 11/05/2022] Open
Abstract
The increasing number of patients who desire to experience vaginal birth after cesarean (VBAC) and the optimized protocols for trial of labor after cesarean (TOLAC) has led to a shift of old obstetrical paradigms. The VBAC trend is accompanied with numerous challenges for healthcare professionals, from establishing suitability of each pregnant patient profile for TOLAC to active labor management, and ethical or legal issues, which occasionally are not included in specific guidelines. That is why an individualized risk assessment and management can serve obstetricians as a useful tool for improving outcomes of patients, satisfaction, and also for avoiding legal or moral liabilities. The risk management concept aims to reduce foreseen risks and to emulate strategies for prediction and prevention of unwanted events. In obstetrics, and particularly for the VBAC topic, this concept is relatively new and undefined, and thus its features are disparate between guideline recommendations and clinical studies. This narrative review intends to offer a new and organic perspective over clinical aspects of TOLAC and VBAC risk management.
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Affiliation(s)
- Alexandru Carauleanu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ingrid Andrada Tanasa
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Vaginal Delivery After External Cephalic Version in Patients With a Previous Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol 2020; 136:965-971. [PMID: 33030882 DOI: 10.1097/aog.0000000000004065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To estimate the rate of vaginal delivery after successful external cephalic version for breech presentation in women with compared with without a previous cesarean birth. DATA SOURCES We searched MEDLINE, Scopus, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the mode of delivery after successful external cephalic version in women with and without a previous cesarean birth. METHODS OF STUDY SELECTION Two reviewers independently identified studies, extracted data, and evaluated study quality. The rate of vaginal delivery after successful external cephalic version in women with and without a previous cesarean birth was compared, and odds ratios (ORs) with 95% CIs were estimated. TABULATION, INTEGRATION, AND RESULTS Six cohort studies and two case-control studies, reporting on 14,515 women were identified. The median point prevalence of a successful external cephalic version was 74% (interquartile range 63-81%) in women with a previous cesarean birth compared with 69% (interquartile range 64-83%) in women without a previous cesarean birth. The overall success rate of external cephalic version in women with a previous cesarean birth was similar compared with women without a previous cesarean birth (pooled OR 0.84, 95% CI 0.61-1.15). The median point prevalence of a vaginal delivery was 75% (interquartile range 61-84%) in women with a previous cesarean birth compared with 92% (interquartile range 85-95%) in women without a previous cesarean birth after a successful external cephalic version. The overall success rate of a vaginal delivery in women with a previous cesarean birth was less compared with women without a previous cesarean birth (pooled OR 0.26, 95% CI 0.14-0.50). A planned subgroup analysis on studies that included only multiparous women in the control group (parity one or greater) noted the overall success rate of external cephalic version in women with a previous cesarean birth 76% (853/1,123) was lower compared with multiparous women without a previous cesarean birth 84% (9,911/11,855) (pooled OR 0.70, 95% CI 0.54-0.89, I 37%). The overall success rate of a vaginal delivery in women with a previous cesarean birth 83% (666/806) was less compared with women without a previous cesarean birth 97% (9,449/9,746) (pooled OR 0.21, 95% CI 0.12-0.39, I 73%). CONCLUSION Women with previous cesarean birth have similar rates of successful external cephalic version when compared with women without a cesarean birth. Although the rate of vaginal delivery is lower, the majority of patients have a successful vaginal birth after cesarean. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020160145.
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Abstract
In the United States, there is a widespread belief that the overall cesarean birth rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean birth, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.
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McLaren R, Atallah F, Fisher N, Minkoff H. Correlation of Obesity with External Cephalic Version Success among Women with One Previous Cesarean Delivery. AJP Rep 2020; 10:e324-e329. [PMID: 33094023 PMCID: PMC7571570 DOI: 10.1055/s-0040-1715173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/13/2020] [Indexed: 10/26/2022] Open
Abstract
Objective Our aim was to assess the correlation of body mass index (BMI) with the success rate of external cephalic version (ECV) among women with one prior cesarean delivery. Study Design A cross-sectional study of pregnant women with one previous cesarean delivery who underwent ECV. The relationship between BMI and success rate of ECV was assessed. Adverse outcomes were also compared between women with an ECV attempt, and women who had a repeat cesarean delivery. Data were extracted from the U.S. Natality Database from 2014 to 2017. Pearson's correlation coefficient was performed to assess the relationship between BMI and success rate of ECV. Results There were 2,329 women with prior cesarean delivery underwent an ECV attempt. The success rate of ECV among the entire cohort was 68.3%. There was no correlation between BMI and success rate of ECV ( r = 0.024, p = 0.239). Risks of adverse maternal and neonatal outcomes were similar between the ECV attempt group and the repeat cesarean delivery group. Conclusion There was no correlation of BMI with the rate of successful ECV among women with one prior cesarean delivery. Given the similar success rates of ECV and adverse outcomes, obese women with one prior cesarean delivery should be offered ECV.
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Affiliation(s)
- Rodney McLaren
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Nelli Fisher
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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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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Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
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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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External cephalic version after previous cesarean section: A cohort study of 100 consecutive attempts. Eur J Obstet Gynecol Reprod Biol 2018; 231:210-213. [PMID: 30412904 DOI: 10.1016/j.ejogrb.2018.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/03/2018] [Accepted: 10/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE External cephalic version is commonly not performed in women with a previous cesarean section. Fear of uterine rupture and cesarean section in labor are prominent. The risks, however, of these are unclear. This study aims to document the safety and efficacy of external cephalic version in women with a prior cesarean section in a series of 100 consecutive attempts, and to perform a literature of the existing literature. STUDY DESIGN This is a retrospective cohort study of prospectively collected data of external cephalic version attempts in women at term with a previous cesarean section, and a literature review of previously published series. External cephalic version was performed by one of 3 experienced operators, with salbutamol tocolysis if appropriate, using ultrasound to visualize the fetal heart and place of fetal parts. RESULTS 100 women with a prior cesarean section underwent external cephalic version over a 16-year period in one institution. 68% had no previous vaginal delivery. The external cephalic version success rate was 50%, and 30 (63.8%) of these subsequently delivered vaginally. There were no cases of uterine rupture or other complications. A literature review of series containing a total of 549 cases revealed no cases of uterine rupture or perinatal death. CONCLUSIONS External cephalic version in women with a prior cesarean section is safe but enables a vaginal birth in only about a third of women.
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10
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McLaren RA, Atallah F, Fisher N, Minkoff H. Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery. AJP Rep 2018; 8:e349-e354. [PMID: 30574429 PMCID: PMC6261738 DOI: 10.1055/s-0038-1676297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2018] [Indexed: 11/07/2022] Open
Abstract
Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% ( p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17-5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19-21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10-2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.
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Affiliation(s)
- Rodney A McLaren
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Nelli Fisher
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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12
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Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (1-3). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (4-6). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
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Bin YS, Roberts CL, Nicholl MC, Ford JB. Uptake of external cephalic version for term breech presentation: an Australian population study, 2002-2012. BMC Pregnancy Childbirth 2017; 17:244. [PMID: 28747173 PMCID: PMC5530508 DOI: 10.1186/s12884-017-1430-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012. METHODS Data from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks' gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined. RESULTS In N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV. Compared to women who were eligible but who did not attempt ECV, those who had ECV were more likely to be older, multiparous, overseas-born, public patients at delivery, and to deliver in tertiary hospitals in urban areas (p < 0.01). Fewer women who underwent ECV smoked during pregnancy, fewer were morbidly obese, and fewer had a hypertensive disorder of pregnancy, compared to those who were eligible. Caesarean section occurred in 25.9% of successful compared to 95.6% of unsuccessful ECVs. Infant outcomes did not differ by ECV success. CONCLUSIONS The majority of women with a breech presentation did not receive ECV. It is unclear whether this is attributable to issues with service provision or low acceptability among women. Policies to improve access to and information about ECV appear necessary to improve uptake among women with term breech presentation. Improved data collection around the diagnosis of breech presentation, ECV attempts, and outcomes may help to identify specific barriers to ECV uptake.
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Affiliation(s)
- Yu Sun Bin
- Clinical and Population Perinatal Health Research, The Kolling Institute, University of Sydney, Building 52, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. .,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, The Kolling Institute, University of Sydney, Building 52, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
| | - Michael C Nicholl
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, The Kolling Institute, University of Sydney, Building 52, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
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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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15
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Weill Y, Pollack RN. The efficacy and safety of external cephalic version after a previous caesarean delivery. Aust N Z J Obstet Gynaecol 2016; 57:323-326. [DOI: 10.1111/ajo.12527] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/31/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Yishay Weill
- Department of Ophthalmology; Shaare Zedek Medical Center; Jerusalem Israel
- Department of Obstetrics & Gynecology; Shaare Zedek Medical Center; Jerusalem Israel
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Weiniger CF, Lyell DJ, Tsen LC, Butwick AJ, Shachar B, Callaghan WM, Creanga AA, Bateman BT. Maternal outcomes of term breech presentation delivery: impact of successful external cephalic version in a nationwide sample of delivery admissions in the United States. BMC Pregnancy Childbirth 2016; 16:150. [PMID: 27392035 PMCID: PMC4938982 DOI: 10.1186/s12884-016-0941-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to define the frequency and predictors of successful external cephalic version in a nationally-representative cohort of women with breech presentations and to compare maternal outcomes associated with successful external cephalic version versus persistent breech presentation. Methods Using the Nationwide Inpatient Sample, a United States healthcare utilization database, we identified delivery admissions between 1998 and 2011 for women who had successful external cephalic version or persistent breech presentation (including unsuccessful or no external cephalic version attempt) at term. Multivariable logistic regression identified patient and hospital-level factors associated with successful external cephalic version. Maternal outcomes were compared between women who had successful external cephalic version versus persistent breech. Results Our study cohort comprised 1,079,576 delivery admissions with breech presentation; 56,409 (5.2 %) women underwent successful external cephalic version and 1,023,167 (94.8 %) women had persistent breech presentation at the time of delivery. The rate of cesarean delivery was lower among women who had successful external cephalic version compared to those with persistent breech (20.2 % vs. 94.9 %; p < 0.001). Compared to women with persistent breech at the time of delivery, women with successful external cephalic version were also less likely to experience several measures of significant maternal morbidity including endometritis (adjusted Odds Ratio (aOR) = 0.36, 95 % Confidence Interval (CI) 0.24–0.52), sepsis (aOR = 0.35, 95 % CI 0.24–0.51) and length of stay > 7 days (aOR = 0.53, 95 % CI 0.40–0.70), but had a higher risk of chorioamnionitis (aOR = 1.83, 95 % CI 1.54–2.17). Conclusions Overall a low proportion of women with breech presentation undergo successful external cephalic version, and it is associated with significant reduction in the frequency of cesarean delivery and a number of measures of maternal morbidity. Increased external cephalic version use may be an important approach to mitigate the high rate of cesarean delivery observed in the United States.
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Affiliation(s)
- Carolyn F Weiniger
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, POB 12000, Israel.
| | - Deirdre J Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lawrence C Tsen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - BatZion Shachar
- Maternal-Fetal Medicine Unit, Department of Obstetrics & Gynecology, Sheba Met & March of Dimes Prematurity Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - William M Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andreea A Creanga
- Department of International Health, International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, USA
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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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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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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Muñoz H, Guerra S, Perez-Vaquero P, Valero Martinez C, Aizpuru F, Lopez-Picado A. Remifentanil versus placebo for analgesia during external cephalic version: a randomised clinical trial. Int J Obstet Anesth 2014; 23:52-7. [DOI: 10.1016/j.ijoa.2013.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
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Burgos J, Cobos P, Rodríguez L, Osuna C, Centeno MM, Martínez-Astorquiza T, Fernández-Llebrez L. Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. BJOG 2013; 121:230-5; discussion 235. [DOI: 10.1111/1471-0528.12487] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J Burgos
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - P Cobos
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - L Rodríguez
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - C Osuna
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - MM Centeno
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - T Martínez-Astorquiza
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - L Fernández-Llebrez
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
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23
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Bourtembourg A, Mangin M, Ramanah R, Maillet R, Riethmuller D. [Breech delivery and scarred uterus: a special obstetrical situation?]. ACTA ACUST UNITED AC 2013; 42:351-8. [PMID: 23453918 DOI: 10.1016/j.jgyn.2012.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 10/17/2012] [Accepted: 10/25/2012] [Indexed: 11/28/2022]
Abstract
AIM The management of breech delivery in patients with a history of caesarean section is a special situation requiring to anticipate the delivery route if the usual prerequisites for the acceptance of vaginal breech delivery are present. Does a history of caesarean section imply a systematic refusal of vaginal delivery in case of breech presentation or an alternative to an iterative caesarean still exists? MATERIALS AND METHODS An observational study was undertaken in our level III labour ward from January 1st 1994 to June 30th 2010 on 91 patients with a history of caesarean section and who had breech deliveries of singleton pregnancies at more than 35weeks of amenorrhea. Maternal, obstetrical and neonatal parameters were collected. Patients were divided into three groups: vaginal delivery, caesarean section after an accepted vaginal birth trial, elective caesarean section. RESULTS The rate of an accepted vaginal birth trial was 24.2% (22 cases) with a 36.4% (eight patients) success rate in this group. There were two (2.9%) unplanned vaginal births. Fourteen patients (15.4%) had caesarian sections after an accepted vaginal birth trial: ten before labour and four during labour for dynamic dystocia or non-reassuring fetal status. Most caesarean sections before labour in case of an accepted vaginal birth trial were justified by an intercurrent factor requiring induction of labour. Neonatal factors did not show any increased morbidity or mortality in the vaginal birth group. No Apgar score was found to be less than or equal to 7 at 5minutes. Umbilical arterial pH and lactate measured as from 2001 were similar between the groups. Indeed, the mean arterial pH after vaginal birth was 7.19 as compared to 7.22 in case of caesarean section after an accepted vaginal birth trial, and 7.26 after elective caesarean section. Likewise, the mean lactate measurement was at 4.71mmol/L after vaginal birth versus 4.54 and 3.07 in the other two groups. Only neonates born after elective caesarean sections were transferred to intensive care (four cases). CONCLUSION Vaginal breech delivery in case of a scarred uterus is possible, if each obstetrical situation is correctly studied to authorize a vaginal birth trial after a careful selection of patients and a strict management of labour. Vaginal birth does not seem to increase maternal and neonatal morbidity and mortality in this situation.
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Affiliation(s)
- A Bourtembourg
- Service de gynécologie-obstétrique, CHU Saint-Jacques, avenue du 8-Mai-1945, 25000 Besançon, France
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Schmitz T. Situations cliniques particulières, maternelles ou fœtales, influençant le choix du mode d’accouchement en cas d’antécédent de césarienne. ACTA ACUST UNITED AC 2012; 41:772-81. [DOI: 10.1016/j.jgyn.2012.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): a prospective trial of vaginal breech versus cephalic delivery. Arch Gynecol Obstet 2012. [DOI: 10.1007/s00404-012-2639-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Burgos J, Melchor JC, Pijoán JI, Cobos P, Fernández-Llebrez L, Martínez-Astorquiza T. A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term. Int J Gynaecol Obstet 2010; 112:48-51. [PMID: 20870233 DOI: 10.1016/j.ijgo.2010.07.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 06/27/2010] [Accepted: 08/24/2010] [Indexed: 11/27/2022]
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Moodley J, Khedun SM, Devjee J. Breech presentation at a district level hospital in South Africa. S Afr Fam Pract (2004) 2010. [DOI: 10.1080/20786204.2010.10873938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Prise en charge de l’accouchement des patientes ayant un antécédent de césarienne. ACTA ACUST UNITED AC 2010; 38:48-57. [DOI: 10.1016/j.gyobfe.2009.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/13/2009] [Indexed: 11/23/2022]
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Choudhury AP, Dawson AJ. Trends in indications for caesarean sections over 7 years in a Welsh district general hospital. J OBSTET GYNAECOL 2009; 29:714-7. [DOI: 10.3109/01443610903191269] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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