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Sekulic S, Stilinovic N, Baturan B, Krsman A, Tesic I, Vejnovic A, Petrovic D, Nikolasevic Z, Mijavec A, Pesic V, Petkovic B. Corrected evaluation of the breech presentation outcome based on etiology of this presentation in congenitally malformed uterus. Front Med (Lausanne) 2023; 10:1160229. [PMID: 37415764 PMCID: PMC10320854 DOI: 10.3389/fmed.2023.1160229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
Background Breech presentation (BP) results from at random filling of the intrauterine cavity, with an equal probability for a BP or cephalic presentation (CP). Each fetus in BP has its "pair" in CP randomly assumed CP. Direct comparison of BP and CP makes bias to less expressed differences between these two groups. It is therefore necessary to subtract the number of fetuses/newborns from the CP set that are identical to the number of fetuses/newborns in the BP set, with identical characteristics, and add this group to the BP set before comparing them to the rest of the CP fetuses/newborns in the matching process. Methods The procedure encompasses nine variables in pregnancies with a congenitally malformed uterus (CMU) identified at the Department of Obstetrics (1985-2014): gestational age, birth mass, birth length, head circumference, shoulders circumference, umbilical length, placental weight, newborn mass/newborn length ratio, and newborn mass/placental mass ratio. Firstly, the probability of BP was determined and its relation to gestational age, physical characteristics, and previous presentations. Then direct comparison as well as case-control matching of the CP and BP were performed. Case-control matching was based on either a single specific variable (M1) or all combined variables (M2). Findings 462 deliveries were identified with CMU. In 81 cases of multiparity, a fetal presentation was found to be an independent event regardless of the previous presentation, gestational age, and newborn physical characteristics. In four types of CMU with 337 deliveries (Bicornuate, Didelphys, Unicornuate, Arcuate), 9 variables with 36 instances of comparison were observed. M1 in 10 instances and M2 in 6 instances showed a statistically significant lower value of breech/random presentation compared with CP. CP have lower value in 2 instances in M1 and 1 in M2. Statistically significant differences were absent without the matching process. Interpretations The study confirms the maximum probability for the BP is 50%. The case-control matching procedure shows that it is able to detect the difference between the breech/random presentation and CP, while the classic method of direct comparison was unable to detect any differences. The outcome of the breech/random presentation in CMU should be evaluated with the described case-control matching procedure.
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Affiliation(s)
- Slobodan Sekulic
- Department of Neurology, University Clinical Center of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nebojsa Stilinovic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Branislava Baturan
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Obstetrics and Gynecology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Anita Krsman
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Obstetrics and Gynecology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Igor Tesic
- Department of Obstetrics and Gynecology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Aleksandra Vejnovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Obstetrics and Gynecology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Djordje Petrovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Obstetrics and Gynecology, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Zeljka Nikolasevic
- Department of Psychology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Vesna Pesic
- Institute for Biological Research “Sinisa Stankovic“, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Branka Petkovic
- Institute for Biological Research “Sinisa Stankovic“, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Unno S, Ogawa K, Nukariya A, Umehara N, Sago H. Predictive factors for successful external cephalic version with regional anesthesia. J Obstet Gynaecol Res 2023; 49:1335-1340. [PMID: 36796109 DOI: 10.1111/jog.15615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
AIM We aimed to investigate predictive factors of successful external cephalic version (ECV) using regional anesthesia. METHODS In this retrospective study, we included women who underwent ECV at our center from 2010 to 2022. The procedure had been conducted using regional anesthesia and the administration of intravenous ritodrine hydrochloride. The primary outcome was the success of ECV, which was defined as the rotation from a non-cephalic to a cephalic presentation. Primary exposures were maternal demographic factors and ultrasound findings at ECV. To determine predictive factors, we conducted a logistic regression analysis. RESULTS Of 622 pregnant women who underwent ECV, missing data on any variables (n = 14) were excluded and the remaining 608 were analyzed. The success rate during the study period was 76.3%. Multiparous women had significantly higher success rates than primiparous women (adjusted odds ratio [OR]: 2.06 [95% confidence interval (CI): 1.31-3.25]). Women with a maximum vertical pocket (MVP) of <4 cm had significantly lower success rates than those with 4 cm < MVP ≤6 cm (OR: 0.56 [95% CI: 0.37-0.86]). The non-anterior placental location was associated with higher success rates than the anterior placental location (OR: 1.46 [95% CI: 1.00-2.17]). CONCLUSIONS Multiparity, MVP >4 cm, and non-anterior placental locations were associated with successful ECV. These three factors could be useful for patient selection for successful ECV.
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Affiliation(s)
- Saori Unno
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kohei Ogawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akinori Nukariya
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nagayoshi Umehara
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Pinto L, Clode N, Ayres‐de‐Campos D. Use of external cephalic version in Portuguese public hospitals. Int J Gynaecol Obstet 2022; 159:398-403. [DOI: 10.1002/ijgo.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/01/2022] [Accepted: 01/12/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Luísa Pinto
- Department of Obstetrics, Gynecology and Reproductive Medicine Santa Maria University Hospital Lisbon Portugal
- Medical School University of Lisbon Portugal
| | - Nuno Clode
- Department of Obstetrics and Gynecology, Hospital CUF Torres Vedras Portugal
| | - Diogo Ayres‐de‐Campos
- Department of Obstetrics, Gynecology and Reproductive Medicine Santa Maria University Hospital Lisbon Portugal
- Medical School University of Lisbon Portugal
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Morris S, Geraghty S, Sundin D. Breech presentation management: A critical review of leading clinical practice guidelines. Women Birth 2021; 35:e233-e242. [PMID: 34253466 DOI: 10.1016/j.wombi.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/23/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Clinical practice guidelines are designed to guide clinicians and consumers of maternity services in clinical decision making, but recommendations are often consensus based and differ greatly between leading organisations. BACKGROUND Breech birth is a divisive clinical issue, however vaginal breech births continue to occur despite a globally high caesarean section rate for breech presenting fetuses. Inconsistencies are known to exist between clinical practice guidelines relating to the management of breech presentation. AIM The aim of this review was to critically evaluate and compare leading obstetric clinical practice guidelines related to the management of breech presenting fetuses. METHODS Leading obstetric guidelines were purposively obtained for review. Analysis was conducted using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist and reviewing the content of each guideline. FINDINGS Antenatal care recommendations and indications for Caesarean Section were relatively consistent between clinical guidelines. However, several inconsistencies were found among the other recommendations in terms of birth mode counselling, intrapartum management and the basis for recommendations. DISCUSSION Inconsistencies noted in the clinical practice guidelines have the potential to cause issues related to valid consent and create confusion among clinicians and maternity consumers. CONCLUSION Clinical practice guidelines, which focus on the risks of a Vaginal Breech Birth without also discussing the risks of a Caesarean Section when a breech presentation is diagnosed, has the potential to sway clinician attitudes and impact birth mode decision-making in maternity consumers. To respect pregnant women's autonomy and fulfil the legal requirements of consent, clinicians should provide balanced counselling.
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Affiliation(s)
- Sara Morris
- Edith Cowan University; King Edward Memorial Hopsital.
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Yabuzaki K, Kamide T, Ejima R, Tsuruoka Y, Sato M, Kondo I, Hasegawa A, Sato T, Samura O, Okamoto A. Alteration of circulating cell-free DNA level by external cephalic version: A potential biomarker for direct evaluation of placental damage. J Obstet Gynaecol Res 2021; 47:3144-3150. [PMID: 34189855 DOI: 10.1111/jog.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
AIM To confirm that variations in cell-free fetal DNA (cffDNA) are indicators of external placental damage, we quantitatively investigated cffDNA alterations in maternal peripheral blood during external cephalic version (ECV). METHODS We recruited 48 singleton pregnant women who underwent ECV in our hospital. Before and immediately after ECV, we harvested 10 ml of maternal peripheral blood samples for cffDNA analysis. cffDNA alterations were assessed based on the fetal fraction (FF) rate. We performed ECV without epidural anesthesia but administered epidural anesthesia if ECV was disrupted due to severe pain. RESULTS The FF increased from 22.9% ± 5.7% to 27.0% ± 5.7% (p < 0.05) after ECV. The FF increased in both successful (before, 24.4% ± 5.9%; after, 28.1% ± 5.9%; p < 0.05) and unsuccessful (before, 21.8% ± 3.8%; after, 27.3% ± 4.2%; p < 0.05) cases, as well as in patients who received epidural anesthesia (before, 23.9% ± 4.7%; after, 28.5% ± 4.4%; p < 0.05) or underwent ECV more than once (before, 23.5% ± 6.1%; after, 28.4% ± 5.3%; p < 0.05). CONCLUSIONS FF alterations increased due to external stresses during ECV; the alterations were markedly greater when the strength and duration of external stress increased. These FF alterations may serve as potential biomarkers for the direct assessment of placental damage.
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Affiliation(s)
- Keiko Yabuzaki
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taizan Kamide
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ruriko Ejima
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuto Tsuruoka
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mariko Sato
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ibuki Kondo
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Hasegawa
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taisuke Sato
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Papadakis K, Myriknas S, Kidd L, Singh N. Obstetric outcomes after instituting a dedicated External Cephalic Version clinic in a large tertiary centre: a 3-year prospective cohort study. HYPERTENSION RESEARCH IN PREGNANCY 2020. [DOI: 10.14390/jsshp.hrp2020-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos Papadakis
- Specialist Registrar in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Queen Elizabeth University Hospital
| | - Stelios Myriknas
- Clinical Fellow in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust
| | - Louise Kidd
- Senior Midwife, Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust
| | - Natasha Singh
- Consultant in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust
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Savchenko J, Lindqvist PG, Wendel SB. External cephalic version for breech presentation: The guideline landscape and a quest for an optimal approach. Eur J Obstet Gynecol Reprod Biol 2020; 255:197-202. [PMID: 33147532 DOI: 10.1016/j.ejogrb.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to illuminate differences in guidelines for external cephalic version (ECV) for breech presentation at or near term and assess their impact on effectiveness of the procedure in order to improve policymaking. STUDY DESIGN Guidelines from all Swedish ECV providers (hospitals with labor wards, n = 44) were retrieved in 2019 and assessed for similarities and differences. The scoring system based on the identified differences in timing, contraindications and periprocedural care was created. The hospitals were subsequently classified into either restrictive or liberal with regard to ECV. This classification was verified by comparing selection of patients for ECV attempts between the two groups. Our main outcomes were ECV success rate and effectiveness in reducing the remaining breech births and breech cesarean sections. RESULTS Important differences in timing of ECV, contraindications, periprocedural care, and counselling after failed ECV attempt were found. Two thirds of the hospitals were considered liberal and one third restrictive with regard to ECV. ECV success rate was significantly higher in hospitals with a liberal attitude towards ECV compared with restrictive hospitals (54.0 % vs 50.5 %, p = 0.015). Liberal hospitals had a significantly lower proportion of remaining breech births (2.81 % vs 3.01 %, p = 0.009) and breech cesarean sections at or near term (2.49 % vs 2.72 %, p = 0.003). CONCLUSION Important differences in ECV guidelines were found. Hospitals with guidelines reflecting a liberal attitude to ECV had a higher ECV success rate, despite a less strict patient selection, and a lower proportion of breech births and breech cesarean sections, which is the aim of ECV. We recommend avoiding routine ill-founded restrictivity in ECV guidelines and support a more nuanced counselling.
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Affiliation(s)
- Julia Savchenko
- Department of Obstetrics and Gynecology, Stockholm South General Hospital (Södersjukhuset), Stockholm, Sweden; Department of Clinical Science and Education, Stockholm South General Hospital (Södersjukhuset), Karolinska Institutet, Stockholm, Sweden.
| | - Pelle G Lindqvist
- Department of Obstetrics and Gynecology, Stockholm South General Hospital (Södersjukhuset), Stockholm, Sweden; Department of Clinical Science and Education, Stockholm South General Hospital (Södersjukhuset), Karolinska Institutet, Stockholm, Sweden
| | - Sophia Brismar Wendel
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Tsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. Management of Breech Presentation: A Comparison of Four National Evidence-Based Guidelines. Am J Perinatol 2020; 37:1102-1109. [PMID: 31167240 DOI: 10.1055/s-0039-1692391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The management of breech presentation may improve perinatal outcomes. The aim of this study was to synthesize and compare published evidence of four national guidelines on breech presentation. STUDY DESIGN A descriptive review of four recently published national guidelines on breech presentation and external cephalic version (ECV) was conducted: Royal College of Obstetricians and Gynaecologists guideline on "External Cephalic Version and Reducing the Incidence of Term Breech Presentation" and "Management of Breech Presentation", American College of Obstetricians and Gynecologists guideline on "External Cephalic Version" and "Mode of Term Singleton Breech Delivery," Society of Obstetricians and Gynaecologists of Canada guideline on "Vaginal Delivery of Breech Presentation" and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists guideline on "Management of breech presentation at term." RESULTS Regarding ECV, there is no recommendation by the SOGC, whereas all other national guidelines recommend this technique. Regarding breech vaginal delivery, there are limited recommendations by the ACOG, whereas all other guidelines provide similar recommendations. The RANZCOG makes no special recommendations on the intrapartum period. CONCLUSION The differences among national guidelines point out the need for the adoption of an international consensus on the management of breech presentation.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
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López-Pérez R, Lorente-Fernández M, Velasco-Martínez M, Martínez-Cendán JP. Prediction model of success for external cephalic version. Complications and perinatal outcomes after a successful version. J Obstet Gynaecol Res 2020; 46:2002-2009. [PMID: 32779362 DOI: 10.1111/jog.14385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022]
Abstract
AIM External cephalic version (ECV) is an effective and safe technique for avoiding breech presentation at birth. However, it continues rejected by many women. The aim of this study is to develop a predictive model of success of external cephalic version, determine the safety of the technique and perinatal outcomes after successful version. METHODS Data from 317 versions performed over a 6-year period were collected. Different clinical and ultrasound variables, complications, vaginal delivery after successful version and perinatal outcomes were analyzed. RESULTS The overall success rate was 72% (229 of 317 versions). The variables most related to success were parity, placental location, amniotic fluid volume, fetal sex, fetal head palpation and descent of the presenting part. A model for calculating the probability of success was developed in which to input parity, placentation and amniotic fluid data. The model correctly classified 98.8% of successful technique and 74% of all women. Complications were very few and mostly mild. Of women who had success, 77% (163 of 212) had a vaginal birth. No differences between neonatal outcomes were found. CONCLUSION External cephalic version is a successful, safe technique with a high rate of subsequent vaginal delivery. A success prediction model based on some very easily obtained variables can personalize the probability of success.
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Affiliation(s)
- Rocío López-Pérez
- Health Sciences PhD Program, Catholic University of Murcia UCAM, Guadalupe, Murcia, Spain
| | - Mónica Lorente-Fernández
- Department of Obstetrics and Gynecology, University General Hospital Santa Lucía, Cartagena, Spain
| | - María Velasco-Martínez
- Department of Obstetrics and Gynecology, University General Hospital Santa Lucía, Cartagena, Spain
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Leeman L. State of the breech in 2020: Guidelines support maternal choice, but skills are lost…. Birth 2020; 47:165-168. [PMID: 32128861 DOI: 10.1111/birt.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Carbillon L, Benbara A, Tigaizin A, Murtada R, Fermaut M, Belmaghni F, Bricou A, Boujenah J. Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies. BMC Pregnancy Childbirth 2020; 20:263. [PMID: 32359354 PMCID: PMC7196223 DOI: 10.1186/s12884-020-2831-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies. Main body In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed. Conclusion The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route.
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Affiliation(s)
- Lionel Carbillon
- Department of Obstetrics and Gynecology, Sorbonne Paris Nord University, Assistance Publique - Hopitaux de Paris, Avenue du 14 juillet, Hôpital Jean Verdier, 93140, Bondy Cedex, France. .,Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France.
| | - Amelie Benbara
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Ahmed Tigaizin
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Rouba Murtada
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Marion Fermaut
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Fatma Belmaghni
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Jeremy Boujenah
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
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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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Dochez V, Esbelin J, Misbert E, Arthuis C, Drouard A, Badon V, Fenet O, Thubert T, Winer N. Effectiveness of nitrous oxide in external cephalic version on success rate: A randomized controlled trial. Acta Obstet Gynecol Scand 2019; 99:391-398. [PMID: 31630398 DOI: 10.1111/aogs.13753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Approximately 4% of singleton pregnancies at term are in breech presentation. External cephalic version (ECV) can reduce the risks of noncephalic birth and cesarean delivery, but this maneuver can be painful. Our aim was to analyze the effect of administering inhaled nitrous oxide for analgesia on the ECV success rate. MATERIAL AND METHODS This prospective, randomized, single-blind, controlled trial included women with singleton pregnancies in breech presentation at term who were referred for ECV in a tertiary care center. Women were assigned according to a balanced (1:1) restricted randomization design to inhale either nitrous oxide (N2 O) in a 50:50 mix with oxygen or medical air during the procedure. The main outcomes reported are the ECV success rate, degree of pain, adverse event rate, and women's satisfaction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01948115. RESULTS The study included 150 women (nitrous oxide group: n = 74; medical air: n = 76). Inhaled nitrous oxide was not associated with a higher ECV success rate than medical air (24.3 vs 19.7%, P = 0.51). Among parous women (n = 34 in each group), the ECV success rate appeared higher in the nitrous oxide group, respectively 47.1% (n = 16) vs 23.5% (n = 8) (P = 0.042). Neither the median pain level nor adverse event rates differed significantly in women with inhaled nitrous oxide compared with medical air. CONCLUSIONS Use of an equimolar mixture of oxygen and nitrous oxide during ECV appears safe. Although it does not seem to change the overall success rate, it may increase success in parous women.
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Affiliation(s)
- Vincent Dochez
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC), University Hospital of Nantes, Nantes, France
| | - Julie Esbelin
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Emilie Misbert
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC), University Hospital of Nantes, Nantes, France
| | - Chloé Arthuis
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC), University Hospital of Nantes, Nantes, France
| | - Anne Drouard
- Clinical Investigation Center (CIC), University Hospital of Nantes, Nantes, France
| | - Virginie Badon
- Clinical Investigation Center (CIC), University Hospital of Nantes, Nantes, France
| | - Olivier Fenet
- Biometrics and Biostatistics Platform, University Hospital of Nantes, Nantes, France
| | - Thibault Thubert
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC), University Hospital of Nantes, Nantes, France
| | - Norbert Winer
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC), University Hospital of Nantes, Nantes, France
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Reviving external cephalic version: a review of its efficacy, safety, and technical aspects. Obstet Gynecol Sci 2019; 62:371-381. [PMID: 31777732 PMCID: PMC6856475 DOI: 10.5468/ogs.2019.62.6.371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 11/11/2022] Open
Abstract
Currently, the rate of cesarean sections being performed in Korea is approximately 40%, with Korea ranking 4th among the Organization for Economic Co-operation and Development countries with respect to cesarean deliveries. Breech presentation at term is an important indication for cesarean section among other factors, including medicolegal concerns and pregnancies in women of advanced maternal age. Term breech presentation is associated with a higher fetal mortality rate than that associated with a cephalic presentation. Therefore, in Korea, most of these women deliver by cesarean section to avoid the complications of vaginal breech delivery. However, cesarean section is itself associated with considerable obstetric morbidity and sometimes, mortality. External cephalic version (ECV) is a useful method to reduce the cesarean section rate in women with breech presentation and therefore to reduce the incidence of breech presentation at delivery. Studies have shown that routine use of ECV reduces the cesarean section rate by approximately two-thirds in term pregnancies with breech presentation. ECV is accepted as a safe, efficacious, and cost-effective method and is recommended by both the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists in all pregnancies with term breech presentation, if not contraindicated. In Korea, although most clinicians are aware of the option of ECV, their relative lack of experience in performing the procedure and fear of complications render them hesitant to perform ECV. This review is aimed at guiding obstetricians by describing the efficacy, safety concerns, and technical aspects of this procedure.
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15
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Trobo D, Pintado P, Ortega V, Yllana F, Hernández C, Mendizábal R, De León-Luis J. Maternal and perinatal outcomes in external cephalic version: prognostic factors for the success of the technique. J Perinat Med 2019; 47:717-723. [PMID: 31369397 DOI: 10.1515/jpm-2019-0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/03/2019] [Indexed: 11/15/2022]
Abstract
Background We aimed to analyze the success rate of external cephalic version (ECV) for breech presentations performed in our center between March 2011 and March 2016. We evaluated factors related to a successful ECV, delivery mode, complications and newborn status after ECV. Methods Analysis of assembled data of 327 consecutive ECVs in the third trimester was done. Results The total success rate was 56.6%. After a successful ECV, 85.9% of the fetuses were delivered vaginally. Logistic regression analysis of background factors leading to a successful ECV showed that tocolysis with ritodrine and anterior placenta were each significantly correlated with the rate of successful version. No severe complications were registered during the ECVs, and all babies had normal Apgar scores at delivery. Conclusion These findings suggest that attempting an ECV in breech presentations, once or even twice, seems to be an appropriate management given that a successful ECV decreases the rate of cesarean section in this group of patients and by doing so, it might also decrease the risk of cesarean sections in future pregnancies.
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Affiliation(s)
- Duna Trobo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense, 48 O' Donnell Street, 28009 Madrid, Spain
| | - Pilar Pintado
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense, 48 O' Donnell Street, 28009 Madrid, Spain
| | - Virginia Ortega
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense, 48 O' Donnell Street, 28009 Madrid, Spain
| | - Fátima Yllana
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense, 48 O' Donnell Street, 28009 Madrid, Spain
| | - Concepción Hernández
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense, 48 O' Donnell Street, 28009 Madrid, Spain
| | - Rafael Mendizábal
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense, 48 O' Donnell Street, 28009 Madrid, Spain
| | - Juan De León-Luis
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense, 48 O' Donnell Street, 28009 Madrid, Spain
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16
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Thissen D, Swinkels P, Dullemond RC, van der Steeg JW. Introduction of a dedicated team increases the success rate of external cephalic version: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 236:193-197. [PMID: 30965185 DOI: 10.1016/j.ejogrb.2019.04.002] [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: 12/20/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the influence of a dedicated team on the success rate of external cephalic version and mode of delivery. STUDY DESIGN This prospective cohort study included 673 women with a singleton fetus in breech presentation who underwent external cephalic version between January 2013 and December 2017 at Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. In January 2014, a dedicated team consisting of six gynaecologists and six midwives was introduced at the study clinic. The success rate of external cephalic version and mode of delivery were analysed. In addition, predictors for success were examined by logistic regression analysis. Successful external cephalic version was defined as fetal cephalic presentation immediately following the procedure. RESULTS Following the introduction of a dedicated team in 2014, the success rate of external cephalic version increased from 39.8% in 2013 to 69.5% in 2017 (p < 0.001), with the greatest increase in nulliparous women (from 23.5% to 58.5%, p = 0.002). Over the 5-year study period, the vaginal delivery rate after external cephalic version increased from 43% in 2013 to 71% in 2017 (p < 0.05). The rate of caesarean section after external cephalic version decreased from 55% to 27% (p < 0.05). Anterior placenta [odds ratio (OR) 0.7, 95% confidence interval (CI) 0.48‒0.97] and complete breech (OR 0.2, 95% CI 0.07‒0.90) were significantly associated with a lower success rate. CONCLUSIONS This study showed that introduction of a dedicated team led to a significant increase in the success rate of external cephalic version, and a significant decrease in the rate of caesarean section for women presenting with breech in pregnancy.
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Affiliation(s)
- Daniek Thissen
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
| | - Pauline Swinkels
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Remke C Dullemond
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Jan Willem van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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17
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Melo P, Georgiou EX, Hedditch A, Ellaway P, Impey L. External cephalic version at term: a cohort study of 18 years' experience. BJOG 2018; 126:493-499. [PMID: 30223309 DOI: 10.1111/1471-0528.15475] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the outcome of referrals for external cephalic version (ECV). DESIGN Retrospective cohort study of prospectively collected data. SETTING Major university hospital, UK. SAMPLE Women with non-cephalic presentation at term and no prior caesarean, referred to a specialist clinic. METHODS Details of referrals, ECV attempts, and perinatal outcomes were prospectively collected and analysed. Multivariate binary logistic regression models were created to determine independent predictors of ECV success, reversion, and spontaneous version. MAIN OUTCOME MEASURES External cephalic version success rates, predictors of success and cephalic presentation at birth, and perinatal outcomes. RESULTS Three thousand eight had confirmed breech presentation; 2614 women underwent ECV. Ineligibility for ECV occurred in 117 breech presentations (3.9%), and 297 eligible women (10.2%) declined it. ECV was successful in 1280 (49.0%, 95% CI 47.0-50.9%) (40% in nulliparous women; 64% in others); 1234 (97.3%) were cephalic at birth. Spontaneous version after failure occurred in 4.3% and was more common in multiparas (aOR 2.47, 95% CI 1.43-4.26) and those with a posterior fetal back (aOR 6.09, 95% CI 1.90-19.53). Reversion after successful ECV occurred in 2.2%. In women with a successful ECV whose fetus remained cephalic at birth, 85.7% delivered vaginally. The corrected perinatal mortality of the ECV cohort was 0.12%. CONCLUSION External cephalic version has a low complication rate and is effective for most breech presentations, enabling vaginal birth and avoiding caesarean section. TWEETABLE ABSTRACT External cephalic version can safely be performed with most breech presentations.
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Affiliation(s)
- P Melo
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - E X Georgiou
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A Hedditch
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - P Ellaway
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - L Impey
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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18
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Velzel J, Schuit E, Vlemmix F, Molkenboer JFM, Van der Post JAM, Mol BW, Kok M. Development and internal validation of a clinical prediction model for external cephalic version. Eur J Obstet Gynecol Reprod Biol 2018; 228:137-142. [PMID: 29940417 DOI: 10.1016/j.ejogrb.2018.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 06/10/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To develop a prediction model for the chance of successful external cephalic version (ECV). STUDY DESIGN This is a secondary analysis of a multicenter, open-label randomized controlled trial that assessed the effectiveness of atosiban compared to fenoterol as uterine relaxant during ECV in women with a singleton fetus in breech presentation with a gestational age of 36 weeks or more. Potential predictors included maternal, pregnancy, fetal, and treatment characteristics and were recorded in all participants. Multivariable logistic regression analysis with a stepwise backward selection procedure was used to construct a prediction model for the occurrence of successful ECV. Model performance was assessed using calibration and discrimination. RESULTS We included a total of 818 women with an overall ECV success rate of 37%. Ten predictive factors were identified with the stepwise selection procedure to be associated with a successful ECV: fenoterol as uterine relaxant, nulliparity, Caucasian ethnicity, gestational age at ECV, Amniotic Fluid Index, type of breech presentation, placental location, breech engagement, possibility to palpate the head and relaxation of the uterus. Our model showed good calibration and a good discriminative ability with a c-statistic of 0.78 (95% CI 0.75 to 0.81). CONCLUSION Prediction of success of ECV seems feasible with a model showing good performance. This can be used in clinical practice after external validation.
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Affiliation(s)
- Joost Velzel
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Ewoud Schuit
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floortje Vlemmix
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan F M Molkenboer
- Department of Obstetrics and Gynaecology, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Joris A M Van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton, Victoria, Australia
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
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19
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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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20
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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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22
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Abstract
Breech presentation is the most common abnormal fetal presentation and complicates approximately 3% to 4% of all pregnancies. External cephalic version (ECV) should be recommended to women with a breech singleton pregnancy, if there is no maternal or fetal contraindication. ECV increases the chance of cephalic presentation at the onset of labor and decreases the rate of cesarean delivery by almost 40%. The success rate of ECV is approximately 60%. Review of the risks and benefits for performing an ECV and for both the timing of ECV and the number of attempts should be should be discussed with the patient.
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Affiliation(s)
- Stephanie Lim
- Division of Obstetric Anesthesia, Department of Anesthesia & Perioperative Care, University California San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Jennifer Lucero
- Division of Obstetric Anesthesia, Department of Anesthesia & Perioperative Care, University California San Francisco School of Medicine, San Francisco, CA 94143, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, University California San Francisco School of Medicine, San Francisco, CA 94143, USA.
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23
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Bin YS, Roberts CL, Nicholl MC, Nassar N, Ford JB. Contribution of changing risk factors to the trend in breech presentation at term. Aust N Z J Obstet Gynaecol 2016; 56:564-570. [DOI: 10.1111/ajo.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Yu Sun Bin
- Clinical and Population Perinatal Health Research The Kolling Institute St Leonards New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Christine L. Roberts
- Clinical and Population Perinatal Health Research The Kolling Institute St Leonards New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Michael C. Nicholl
- Department of Obstetrics and Gynaecology Royal North Shore Hospital St Leonards New South Wales Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy Sydney School of Public Health University of Sydney Sydney New South Wales Australia
| | - Jane B. Ford
- Clinical and Population Perinatal Health Research The Kolling Institute St Leonards New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
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Affiliation(s)
- Daniel W Skupski
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Alessandro Ghidini
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA, USA
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25
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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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Abstract
Fetal malpresentation is an important cause of the high cesarean delivery rate in the United States and around the world. This includes breech, face, brow, and compound presentations as well as transverse lie. Risk factors include multiparity, previously affected pregnancy, polyhydramnios, and fetal and uterine anomalies. Appropriate management can reduce the need for cesarean delivery in some cases. This review discusses management options and focuses specifically on external cephalic version and vaginal breech delivery.
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Velzel J, de Hundt M, Mulder FM, Molkenboer JF, Van der Post JA, Mol BW, Kok M. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 195:160-167. [DOI: 10.1016/j.ejogrb.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/29/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Ebner F, Friedl TWP, Leinert E, Schramm A, Reister F, Lato K, Janni W, DeGregorio N. Predictors for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet 2015; 293:749-55. [DOI: 10.1007/s00404-015-3902-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
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Sharoni L, Lyell DJ, Weiniger CF. Too late to back out? Options for breech presentation management. J Epidemiol Community Health 2015; 69:1135-8. [PMID: 26139643 DOI: 10.1136/jech-2015-205528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Limor Sharoni
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Deirdre J Lyell
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Carolyn F Weiniger
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Hemelaar J, Lim LN, Impey LW. The Impact of an ECV Service is Limited by Antenatal Breech Detection: A Retrospective Cohort Study. Birth 2015; 42:165-72. [PMID: 25872703 DOI: 10.1111/birt.12162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND External cephalic version (ECV) reduces the chance of breech presentation at term birth and lowers the chance of a cesarean delivery. ECV services are now in place in many units in the United Kingdom but their effectiveness is unknown. The aim of this study was to investigate the reasons for breech presentation at term birth. METHODS We performed a retrospective cohort study of 394 consecutive babies who were in breech presentation at term birth in a large United Kingdom maternity unit that offers ECV. The cohort was analyzed over two time periods 10 years apart: 1998-1999 and 2008-2009. RESULTS Only 33.8 percent of women had undergone a (failed) ECV attempt. This low proportion was mainly because breech presentation was not diagnosed antenatally (27.9%). Other contributing factors were: ECV not offered by clinicians (12.2%), ECV declined by women (14%), and contraindications to ECV (10.7%). Over the 10-year period, the proportion of breech presentations that were not diagnosed antenatally increased from 23.2 to 32.5 percent (p = 0.04), which constituted 52.8 percent of women who had not undergone an ECV attempt in 2008-2009. Failure of clinicians to offer ECV reduced from 21.6 to 3.0 percent (p = 0.0001) and the proportion of women declining ECV decreased from 19.1 to 9.0 percent (p = 0.005). Overall, ECV attempts increased from 28.9 to 38.5 percent (p = 0.05). CONCLUSIONS Although ECV counseling, referral, and attempt rates have increased, failure to detect breech presentation antenatally is the principal barrier to successful ECV. Improved breech detection would have a greater impact than methods to increase ECV success rates.
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Affiliation(s)
- Joris Hemelaar
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK.,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee N Lim
- Department of Obstetrics & Gynaecology, The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lawrence W Impey
- Fetal and Maternal Medicine, The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Sharoni L, Weiniger CF. Anesthesia and External Cephalic Version. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0095-0] [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]
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Hunter LA. Vaginal Breech Birth: Can We Move Beyond the Term Breech Trial? J Midwifery Womens Health 2014; 59:320-7. [DOI: 10.1111/jmwh.12198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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