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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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Azimirad A. What to do when it is breech? A state-of-the-art review on management of breech presentation. World J Obstet Gynecol 2023; 12:1-10. [DOI: 10.5317/wjog.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/15/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023] Open
Abstract
Any non-cephalic presentation in a fetus is regarded as malpresentation. The most common malpresentation, breech, contributes to 3%-5% of term pregnancies and is a leading indication for cesarean delivery. Identification of risk factors and a proper physical examination are beneficial; however, ultrasound is the gold standard for the diagnosis of malpresentations. External cephalic version (ECV) refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation. This procedure is performed manually through the mother’s abdomen by a trained health care provider, to reduce the likelihood of a cesarean section. Studies have reported a version success rate of above 50% by ECV. The main objective of this review is to present a broad perspective on fetal malpresentation, ECV, and delivery of a breech fetus. The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them. After discussing breech prevalence, risk factors, diagnosis, and management, an updated review of ECV is presented. Moreover, ECV indications/contraindications, alternatives, clinical techniques on how to perform ECV and breech vaginal delivery, and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
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Affiliation(s)
- Afshin Azimirad
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA 02111, United States
- Diabetes Clinical Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
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Zhang N, Ward H. Safety and efficacy of external cephalic version after a previous caesarean delivery: A systematic review. Aust N Z J Obstet Gynaecol 2021; 61:650-657. [PMID: 34169515 DOI: 10.1111/ajo.13399] [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: 03/17/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND External cephalic version (ECV) is a common procedure and has been shown to be safe and effective in turning a baby from a breech to cephalic presentation. However, whether ECV is safe and effective in women with a scarred uterus from a previous caesarean section remains contentious. AIM To evaluate the safety and efficacy of external cephalic version in women with a singleton breech pregnancy and at least one previous caesarean delivery. MATERIAL AND METHODS Literature searches were conducted on MEDLINE, PUBMED, EMBASE, CINAHL and SCOPUS up to June 2020. The search strategy included the following keywords: ('external cephalic version OR ECV') AND ('previous OR prior OR past' AND 'caesarean OR caesarean OR uterine scar'). Studies were included if they evaluated the efficacy and/or safety of external cephalic version in women after 36 weeks' gestation with a singleton breech pregnancy and at least one previous caesarean delivery. RESULTS Nine studies were included in the review. ECV success rates and subsequent vaginal delivery rates ranged from 50 to 100% and from 50 to 74.9%, respectively. ECV complications reported included abnormal fetal heart rate, abnormal cardiotocography and transient vaginal bleeding. No studies reported cases of uterine rupture. CONCLUSIONS ECV in women with a previous caesarean delivery is a relatively successful and low-risk procedure compared to women without a previous caesarean delivery. The results from this systematic review provide useful information for professional bodies in updating clinical guidelines such that ECV may be offered to women with one previous caesarean delivery.
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Affiliation(s)
- Ning Zhang
- University of New South Wales Rural Clinical School Mid North Coast Division Coffs Harbour Campus, Coffs Harbour, New South Wales, Australia
| | - Harvey Ward
- University of New South Wales Rural Clinical School Mid North Coast Division Coffs Harbour Campus, Coffs Harbour, New South Wales, Australia.,Department Obstetrics and Gynaecology, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,Centre for Women's Reproductive Care, Coffs Harbour, New South Wales, Australia
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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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Kohls F, Gebauer F, Flentje M, Brodowski L, von Kaisenberg CS, Jentschke M. Current Approach for External Cephalic Version in Germany. Geburtshilfe Frauenheilkd 2020; 80:1041-1047. [PMID: 33012836 PMCID: PMC7518935 DOI: 10.1055/a-1127-8646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 10/26/2022] Open
Abstract
Introduction Fetal breech presentation at terms occurs in 3 - 6% of pregnancies. External cephalic version can reduce the number of cesarean sections and vaginal breech deliveries. Different approaches are used to carry out external cephalic version. This study looked at the different approaches used in Germany and compared the approach used with the recommendations given in German and international guidelines. Material and Methods An anonymized online survey of 234 hospitals in Germany was carried out in 2018. In addition to asking about hospital structures, questions also focused on how external version was carried out in practice (preparations, tocolysis, anesthetics, etc.), on relative and absolute contraindications and on the success rate. Results 37.2% of the hospitals approached for the survey participated in the study. Of these, 98.8% performed external version procedures. The majority of participating hospitals were university hospitals (26.4%) and maximum care hospitals (35.6%) with an average number of more than 2000 births per year (60.9%). External cephalic version is the preferred (61.7%) obstetrical procedure to deal with breech presentation, rather than vaginal breech birth or primary cesarean section. 45.8% of respondents carry out external version procedures on an outpatient basis, and 42.1% of hospitals perform the procedure as an inpatient intervention, especially from the 37th week of gestation. Prior to performing an external version procedure, 21.6% of surveyed institutions carry out a vaginal examination to evaluate possible fixation of the fetal rump. 95.5% of institutions used fenoterol for tocolytic therapy; the majority using it for continuous tocolysis (70.2%). 1 - 3 attempts at external version (8.4%) were usually carried out by a specific senior physician. In most cases, no analgesics were administered. The reported rate of emergency cesarean sections was very low. The most common indication for emergency C-section was pathological CTG (56,7%). The assessment of relative and absolute contraindications varied, depending on the surveyed hospital. 67.5% asked patients to empty their bladders before carrying out external version, while 10.8% carried out external version when the bladder was filled. The reported success rate was more than 45%. After successful version, only 14.8% of hospitals arranged for patients to wear an abdominal binder. For 32.4%, the decision to apply an abdominal binder was taken on a case-by-case basis. Conclusion The approach used in Germany to carry out external cephalic version is based on the (expired) German guideline on breech presentation. Based on the evidence obtained, a number of individual recommendations should be re-evaluated. More recent international guidelines could be useful to update the standard procedure.
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Affiliation(s)
- Fabian Kohls
- Klinik für Frauenheilkunde und Geburtshilfe, Asklepios Harzklinik Goslar, Goslar, Germany
| | - Friederike Gebauer
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Markus Flentje
- Klinik für Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Lars Brodowski
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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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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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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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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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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Fullerton J, Butler M, Aman C, Reid T. Global competencies for midwives: external cephalic version; ultrasonography, and tobacco cessation intervention. Women Birth 2018; 32:e413-e420. [PMID: 30174206 DOI: 10.1016/j.wombi.2018.08.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
Abstract
PROBLEM AND BACKGROUND The International Confederation of Midwives (ICM) conducts regular updates to the Essential Competencies for Basic Midwifery Practice to determine the introduction or retention of items in the global scope of midwifery practice guidance document. AIM This article presents the review process that underpinned the deliberation about three specific clinical practices: external cephalic version, prenatal ultrasonography, and tobacco cessation interventions that occurred during the 2016-2017 global update study. METHODS A brief outline of the research methodology used in the 2016-2017 study is provided. Literature summaries about safety and effectiveness of three clinical skills are offered. Data addressing global and regional variations in support of each practice and final disposition of the items are documented. FINDINGS External cephalic version did not receive sufficient document support for inclusion in the initial list of items to be tested in the study. Prenatal ultrasonography was supported as an advanced (76.6%) or country-specific (18.8%) skill that midwives could acquire, to promote wider global access for pregnant women. Midwives' participation in tobacco cessation counselling was supported (≥85%) in each of ICM's regions. Knowledge about World Health Organization recommendations for nicotine replacement therapy was endorsed as an additional (62.4%) or country-specific (29.3%) skill. DISCUSSION AND CONCLUSION The current evidence of safety of midwives performing external cephalic version led to the recommendation that it be considered in the next document update. Conflicting views of midwives' role in acquiring skills to conduct prenatal ultrasound were evident. There was strong support for participation in smoking cessation counselling, but knowledge of World Health Organization recommendations was not highly endorsed.
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Affiliation(s)
| | - Michelle Butler
- Faculty of Science and Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Cheryl Aman
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
| | - Tobi Reid
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
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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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Ng'ang'a N, Ratzersdorfer J, Abdelhak Y. Vaginal birth after two previous caesarean deliveries in a patient with uterus didelphys and an interuterine septal defect. BMJ Case Rep 2017; 2017:bcr-2016-219149. [PMID: 28584004 PMCID: PMC5534647 DOI: 10.1136/bcr-2016-219149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 11/04/2022] Open
Abstract
Uterus didelphys is a congenital abnormality characterised by double uteri, double cervices and a double or single vagina that affects 0.3% to 11% of the general female population. A 23-year-old woman, gravida 3 para 3003, with uterus didelphys, acquired an iatrogenic interuterine septal defect during an otherwise routine primary caesarean delivery for fetal malpresentation. The defect was repaired but noted to have dehisced during her second pregnancy. A repeat caesarean section was performed due to fetal malpresentation after an unsuccessful external cephalic version. The dehisced defect was left unrepaired. During her third pregnancy, the placenta implanted in the right uterus, but the fetus migrated to the left uterus at approximately 28 weeks gestation. The umbilical cord traversed the interuterine septal defect. With the fetus in the vertex presentation at term gestation, the patient underwent a vaginal birth after two previous caesarean deliveries without any major perinatal complications.
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Affiliation(s)
- Njoki Ng'ang'a
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jonathan Ratzersdorfer
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
- Maternal Resources, Hackensack, New Jersey, USA
| | - Yaakov Abdelhak
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
- Maternal Resources, Hackensack, New Jersey, USA
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