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Cobec IM, Varzaru VB, Kövendy T, Kuban L, Eftenoiu AE, Moatar AE, Rempen A. External Cephalic Version-A Chance for Vaginal Delivery at Breech Presentation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1619. [PMID: 36363576 PMCID: PMC9693153 DOI: 10.3390/medicina58111619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 03/14/2024]
Abstract
Background and Objectives: In recent years, the rate of caesarean section (CS) has increased constantly. Although vaginal breech delivery has a long history, breech presentation has become the third most common indication for CS. This study aims to identify factors associated with the success of external cephalic version (ECV), underline the success rate of ECV for breech presentation and highlight the high rate of vaginal delivery after successful ECV. Material and Methods: This retrospective observational study included 113 patients with singleton fetuses in breech presentation, who underwent ECV from January 2016 to March 2021 in the Clinic of Obstetrics and Gynecology, Diakonieklinikum Schwäbisch Hall, Germany. Maternal and fetal parameters and data related to procedure and delivery were collected. Possible predictors of successful ECV were evaluated. Results: The success rate of ECV was 54.9%. The overall rate of vaginal birth was 44.2%, regardless of ECV outcome. The vaginal birth rate after successful ECV was 80.6%. Overall, 79.0% of women with successful ECV delivered spontaneously without complications, 19.4% delivered through CS performed during labor by medical necessity, and 1.6% delivered through vacuum extraction. ECV was performed successfully in three of the four women with history of CS. Gravidity, parity, maternal age, gestational age, fetal weight, and amniotic fluid index (AFI) were significantly correlated with the outcome of ECV. Conclusions: ECV for breech presentation is a safe procedure with a good success rate, thus increasing the proportion of vaginal births. Maternal and fetal parameters can be used to estimate the chances of successful ECV.
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Affiliation(s)
- Ionut Marcel Cobec
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Vlad Bogdan Varzaru
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Tamas Kövendy
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Lorant Kuban
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Anca-Elena Eftenoiu
- Clinic of Internal Medicine, Hohenloher Krankenhaus Öhringen, 74613 Öhringen, Germany
| | | | - Andreas Rempen
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
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Zhang Y, Betran AP, Li X, Liu D, Yuan N, Shang L, Lin W, Tu S, Wang L, Wu X, Zhu T, Zhang Y, Lu Z, Zheng L, Gu C, Fang J, Liu Z, Ma L, Cai Z, Yang X, Li H, Zhang H, Zhao X, Yan L, Wang L, Sun X, Luo Q, Liu L, Zhu J, Qin W, Yao Q, Dong S, Yang Y, Cui Z, He Y, Feng X, He L, Zhang H, Zhang L, Wang X, Souza JP, Qi H, Duan T, Zhang J. What is an appropriate caesarean delivery rate for China: a multicentre survey. BJOG 2021; 129:138-147. [PMID: 34559941 PMCID: PMC9297886 DOI: 10.1111/1471-0528.16951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
Objective To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction. Design A multicentre cross‐sectional study. Setting A total of 94 hospitals across 23 provinces in China. Population A total of 73 977 randomly selected deliveries. Methods We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates. Main outcome measures CD rates in China. Results In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs. Conclusions Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD. Tweetable abstract The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%. The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%. Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953.
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Affiliation(s)
- Y Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - A P Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - X Li
- Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - D Liu
- Dongguan City Maternal and Child Health Hospital, Southern Medical University, Guangdong, China
| | - N Yuan
- Department of Obstetrics and Gynaecology, The Second Hospital Affiliated to Shaanxi University of Chinese Medicine, Shaanxi, China
| | - L Shang
- Department of Obstetrics, The Maternal and Child Health Hospital of Xinxiang, Henan, China
| | - W Lin
- Department of Obstetrics, The Maternal and Child Health Hospital of Dalian, Liaoning, China
| | - S Tu
- Department of Obstetrics and Gynaecology, Southwest Medical University, Sichuan, China
| | - L Wang
- Department of Obstetrics and Gynaecology, The First Hospital Affiliated to Kunming Medical University, Yunnan, China
| | - X Wu
- Department of Obstetrics, Jiangsu Women and Child Health Hospital, Jiangsu, China
| | - T Zhu
- The First People's Hospital of Zhaotong, Kunming Medical University, Yunnan, China
| | - Y Zhang
- Department of Obstetrics, The Maternal and Child Health Hospital of Qujing, Yunnan, China
| | - Z Lu
- Suining Central Hospital, Chongqing Medical University, Sichuan, China
| | - L Zheng
- Taizhou Hospital of Zhejiang Province, Zhejiang, China
| | - C Gu
- Yangzhou Maternal and Child Care Service Centre, Jiangsu, China
| | - J Fang
- Qingdao Chengyang People's Hospital, Shandong First Medical University, Shandong, China
| | - Z Liu
- Department of Obstetrics, The Maternal and Child Health Hospital of Baoji, Shaanxi, China
| | - L Ma
- Yanshi City People's Hospital, Henan, China
| | - Z Cai
- Department of Obstetrics and Gynaecology, Aviation Hospital of Beijing, China Medical University, Beijing, China
| | - X Yang
- Department of Obstetrics, The Maternal and Child Health Hospital of Luohu District, Shenzhen, China
| | - H Li
- Yanan University Affiliated Hospital, Shaanxi, China
| | - H Zhang
- Haikou Hospital of the Maternal and Child Health, Hainan, China
| | - X Zhao
- The First People's Hospital of Taizhou, Wenzhou Medical University, Zhejiang, China
| | - L Yan
- The Second Affiliated Hospital of Hebei North University, Hebei, China
| | - L Wang
- Department of Obstetrics and Gynaecology, The 174th Hospital of the Chinese People's Liberation Army, Xiamen University, Fujian, China
| | - X Sun
- Puyang Maternal and Child Care Centres, Henan, China
| | - Q Luo
- Luzhou People's Hospital, Sichuan, China
| | - L Liu
- Affiliated Hospital of Jiangsu University, Jiangsu, China
| | - J Zhu
- The Second People's Hospital of Tongxiang, Zhejiang, China
| | - W Qin
- Department of Obstetrics and Gynaecology, Aviation Hospital of Beijing, China Medical University, Beijing, China
| | - Q Yao
- The Central Hospital of Shaoyang, University of South China, Hunan, China
| | - S Dong
- Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Y Yang
- The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Z Cui
- Department of Obstetrics, The Maternal and Child Health Hospital of Cangzhou, Hebei, China
| | - Y He
- The Second People's Hospital of Qingyuan City, Guangdong, China
| | - X Feng
- Department of Obstetrics and Gynaecology, Fujian Medical University Union Hospital, Fujian Medical University, Fujian, China
| | - L He
- The People's Hospital of Pengzhou, Sichuan, China
| | - H Zhang
- Department of Obstetrics, Eastern District of the Fourth Hospital of Hebei Medical University, Hebei, China
| | - L Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X Wang
- Department of Obstetrics and Gynaecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J P Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil
| | - H Qi
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - T Duan
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - J Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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