[Breech Presentation: CNGOF Guidelines for Clinical Practice - External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation]

YouTube™ as a Source of Information on Acupuncture for Correction of Breech Presentation

BACKGROUND AND AIM

Breech presentation is a condition that occurs in rare cases in pregnancy. Although guidelines recommend a cesarian section or an external cephalic version in case of breech, alternative procedures like acupuncture, are also available. Information on this approach is mostly found by patients through social media; we aimed to study content quality and the reliability of information present on YouTube™ (Google LLC, Mountain View, California, United States), one of the most popular.

METHODS

Two gynecologists and an anesthesiologist, who was qualified as an acupuncturist, rated the reliability and the content quality of 23 of the first 100 results from YouTube. Normal data distribution was tested with the Shapiro-Wilk test. General features of videos, reliability, and content quality were compared with the Wilcoxon-Mann-Whitney test (continuous variables) and the Chi-square test (categorical variables). All tests were two-sided, and the statistical significance level was determined at p<0.05.

RESULTS

Concerning reliability, all videos were rated poorly while only one was judged as sufficiently high in quality content. Lower scores in terms of reliability and content quality resulted from the reviewers' evaluation with no videos reported as suggestable to patients. Two videos were considered fit to be suggested to patients by the gynecologist reviewers.

CONCLUSIONS

Information about the role and the success rate of acupuncture for converting breech presentation found on YouTube are poorly reliable, low-quality, and not valid for patients. It should be a physician's duty to provide correct information to patients.

[Tocolysis during External Cephalic Version (ECV): A retrospective before/after study in a type III maternity hospital]

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.

Cephalic version by postural management in the lateral position without the knee-chest position for primiparous breech presentation: A retrospective cohort study

AIM

This study aimed to determine the efficacy of postural management in the lateral position for primiparous breech presentation.

METHODS

A retrospective cohort study was conducted at a single institution from January 2020 through December 2020. Participants were singleton primiparous pregnant women diagnosed with breech presentation between 28 + 0 and 29 + 6 weeks of gestation. The exclusion criteria were scheduled cesarean delivery, uterine malformation, transverse position, and scheduled delivery at another hospital. A doctor instructed the women in the intervention group to lie on their right sides several times a day if the fetal back was on the left side or lie on their left sides if the fetal back was on the right side. The knee-chest position and other methods were not recommended. The control group received expectant management care. The primary endpoint was the percentage of fetuses in a cephalic presentation 2 weeks later.

RESULTS

Of the 56 women included in the study, 17 women were instructed to lie in the lateral position, and 39 women received expectant management care only. After 2 weeks, women who were instructed to lie in lateral position had a higher rate of fetal cephalic version than the control group (82.4% [14/17] vs. 43.6% [17/39], p = 0.017). No study participants experienced adverse effects.

CONCLUSIONS

Two weeks of postural management in the lateral position without the knee-chest position significantly reduced the rate of primiparous breech presentation in the third trimester of pregnancy.

External cephalic version at 38 weeks' gestation at a specialized German single center

Introduction

Cesarean section (CS) rates are increasing worldwide. One constant indication is the breech presentation at term. By offering external cephalic version (ECV) and vaginal breech delivery CS rates can be further reduced.

Objective

This study aimed to analyze the ECV at 38 weeks of gestation with the associate uptake rate, predicting factors, success rate, and complications at a tertiary healthcare provider in Germany specializing in vaginal breech delivery.

Methods

We conducted a prospective cohort study with retrospective data acquisition. All women with a singleton fetus in breech presentation presenting after 34 weeks of gestation for counseling between 2013 and 2017 were included. ECV impact factors were analyzed using logistic regression.

Results

A total of 1,598 women presented for breech birth planning. ECV was performed on 353 patients. The overall success rate was 22.4%. A later week of gestation (odds ratio [OR] 1.69), an abundant amniotic fluid index (AFI score) (OR 5.74), fundal (OR 3.78) and anterior (OR 0.39) placental location, and an oblique lie (OR 9.08) were significantly associated with successful ECV in our population. No major complications were observed. The overall vaginal delivery rates could be increased to approximately 14% with ECV.

Conclusion

The demand for alternative birth modes other than CS for breech birth is high in the area of Frankfurt, Germany. Our study offers evidence of the safety of ECV at 38 weeks. Centers with expertise in vaginal breech delivery and ECV can reduce CS-rates. To further establish vaginal breech delivery and ECV as alternate options, the required knowledge and skill should be implemented in the revised curricula.

Systematic Kleihauer-Betke Test after External Cephalic Version for Breech Presentation: Is It Useful?

The incidence of fetomaternal hemorrhage (FMH) after external cephalic version (ECV) has been poorly reported. In this study, we evaluated the frequency of FMH, diagnosed by positive Kleihauer–Betke test (KBT), after ECV attempt and then evaluate the relevance of its routine use after procedure. A total of 282 women with a term breech presentation and who had ECV attempt were recruited from January 2014 and December 2018. After ECV attempt, women were systematically screened for FMH using KBT. Data on ECV attempt, KBT results, perinatal and neonatal outcomes were collected and compared between women with positive (cases) and negative KBT (controls) after ECV. The success rate of ECV was 22.0% (62/282). Eight women (2.9%) experienced transient fetal heart rate (FHR) abnormalities after ECV. In five (1.8%) women, KBT was positive after ECV. Obstetrical management was modified for two of these five women due to continuous positivity of KBT at day 1 and day 7 controls after ECV attempt. A cesarean section was planned 7 days earlier due to persistent high FMH on day 7 (6 mL fetal blood) in one woman and the labor was induced for persistent high FMH on day 7 (20 mL fetal blood) for another woman. No newborns have signs of fetal anemia at birth and there was no significant difference in neonatal status between two groups. FMH after ECV attempt are rare, and no negative fetal or neonatal outcomes were observed when KBT was positive, even strongly (>5 mL fetal blood). It appears that systematic KBT after attempted ECV is probably not useful.