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Kabiri D, Haj Yahya R, Yahalomi S, Ezra Y. Impact of full vs empty urinary bladder on external cephalic version success: a randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:100991. [PMID: 38236701 DOI: 10.1016/j.ajogmf.2023.100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND External cephalic version is a procedure used to turn a fetus from a breech position to a cephalic position before delivery. The success rate of the external cephalic version can be affected by various factors; however, the effect of bladder volume on the success rate of the external cephalic version remains controversial. OBJECTIVE This study aimed to determine the effect of urinary bladder status (full or empty) on the success rate of the external cephalic version through a prospective randomized study. STUDY DESIGN This was a prospective randomized controlled trial conducted at a tertiary care obstetrical center. Overall, 70 women with a singleton breech presentation at term undergoing external cephalic version were randomly allocated into 2 groups: external cephalic version with an empty bladder and external cephalic version with a full bladder. The external cephalic version procedure was performed by experienced obstetricians under ultrasound guidance. The primary outcome was the success rate of the external cephalic version. RESULTS The success rate of the external cephalic version was 67.56% (25/37) in the full bladder group and 54.54% (18/33) in the empty bladder group, with no statistically significant difference between the groups (P=.26). In addition, the relative risk of successful external cephalic version was 1.23 (95% confidence interval, 0.84-1.81), indicating no significant difference. CONCLUSION This randomized controlled trial demonstrated that the presence of a full or empty urinary bladder does not significantly affect the success rate of the external cephalic version in women with singleton breech presentation at term. Our findings suggest that women undergoing an external cephalic version do not need to have a full bladder to improve the success rate of the procedure.
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Affiliation(s)
- Doron Kabiri
- Hadassah Medical Organization and Faculty of Medicine, Department of Obstetrics and Gynecology, Hebrew University of Jerusalem, Jerusalem, Israel (Dr Kabiri, Dr Yahya, Dr Yahalomi, and Dr Ezra).
| | - Rani Haj Yahya
- Hadassah Medical Organization and Faculty of Medicine, Department of Obstetrics and Gynecology, Hebrew University of Jerusalem, Jerusalem, Israel (Dr Kabiri, Dr Yahya, Dr Yahalomi, and Dr Ezra); Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia (Dr Yahya)
| | - Shlomi Yahalomi
- Hadassah Medical Organization and Faculty of Medicine, Department of Obstetrics and Gynecology, Hebrew University of Jerusalem, Jerusalem, Israel (Dr Kabiri, Dr Yahya, Dr Yahalomi, and Dr Ezra)
| | - Yossef Ezra
- Hadassah Medical Organization and Faculty of Medicine, Department of Obstetrics and Gynecology, Hebrew University of Jerusalem, Jerusalem, Israel (Dr Kabiri, Dr Yahya, Dr Yahalomi, and Dr Ezra)
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Shinmura H, Matsushima T, Watanabe A, Shi H, Nagashima A, Takizawa A, Yamada M, Harigane E, Tsunoda Y, Kurashina R, Ichikawa G, Suzuki S. Evaluating the effectiveness of lateral postural management for breech presentation: study protocol for a randomized controlled trial (BRLT study). Trials 2023; 24:360. [PMID: 37245031 PMCID: PMC10225078 DOI: 10.1186/s13063-023-07395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 05/19/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Breech presentation is observed in 3-4% at term of pregnancy and is one of the leading causes of cesarean section. There is no established treatment for breech presentation before 36 weeks. A retrospective cohort study was conducted to demonstrate that the lateral position is effective for breech presentation. However, there are no randomized controlled trials evaluating lateral position management for breech presentation. Here, we described the methodology of a randomized controlled trial of a cephalic version for breech presentation in the third trimester by lateral postural management (BRLT study). METHODS The BRLT study is an open-label, randomized controlled trial with two parallel groups allocated in a 1:1 ratio to examine the lateral position management for breech presentation, as compared with expectant management care. An academic hospital in Japan will enroll 200 patients diagnosed with a breech presentation by ultrasonography between 28 + 0 weeks and 30 + 0 weeks. Participants in the intervention group will be instructed to lie on their right sides for 15 min three times per day if the fetal back was on the left side or lie on their left sides if the fetal back was on the right side. The instruction will be given every 2 weeks after confirmation of fetal position, and the lateral position will be instructed until the cephalic version, and after the cephalic version, the reverse lateral position will be instructed until delivery. The primary outcome is cephalic presentation at term. The secondary outcomes are cesarean delivery, cephalic presentation 2, 4, and 6 weeks after the instruction, and at delivery, recurrent breech presentation after cephalic version, and adverse effects. DISCUSSION This trial will answer whether the lateral positioning technique is effective in treating breech presentation and, depending on the results, may provide a very simple, less painful, and safe option for treating breech presentation before 36 weeks, and it may impact breech presentation treatment. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000043613. Registered on 15 March 2021 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049800 .
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Affiliation(s)
- Hiroki Shinmura
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan.
| | - Takashi Matsushima
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Asako Watanabe
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Honglian Shi
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Asako Nagashima
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Ayako Takizawa
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Mayu Yamada
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Eika Harigane
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Youhei Tsunoda
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Ryuhei Kurashina
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Go Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugicho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
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Athiel Y, Girault A, Le Ray C, Goffinet F. Association between hospitals' cesarean delivery rates for breech presentation and their success rates for external cephalic version. Eur J Obstet Gynecol Reprod Biol 2022; 270:156-163. [DOI: 10.1016/j.ejogrb.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/08/2022] [Indexed: 11/17/2022]
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Levin G, Cahan T, Weill Y, Axelrod M, Pollack RN, Meyer R. Ritodrine versus salbutamol for external cephalic version. Minerva Obstet Gynecol 2022; 74:337-342. [PMID: 35107244 DOI: 10.23736/s2724-606x.22.05035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Treatment with beta-agonist tocolytics preceding external cephalic version (ECV) attempt increases success rates. Most studies have focused on intravenously and orally administered beta-agonists, while other administration routes including intramuscularly (IM) and subcutaneously (SC) are understudied. We aimed to compare the efficacy of IM ritodrine to SC salbutamol given prior to ECV. METHODS A retrospective study of patients who underwent ECV between 1/2012 and 12/2019 at two medical centers. We compared patients undergoing ECV following IM ritodrine versus SC salbutamol. We matched the two groups by parity and placental location. Maternal, pregnancy, ECV procedure and neonatal characteristics were compared. RESULTS Overall, 601 women were included in each group. Median maternal age and amniotic fluid index (AFI) were lower in the Ritodrine group (27 vs. 32 years, p<0.001, 11 vs. 15 AFI cm, p<0.001, respectively). The median gestational age at ECV was higher in the Ritodrine group (380/7 vs. 370/7 weeks gestation). Success rate was higher in the Ritodrine group (71.7% vs. 63.8%, p=0.003). Vaginal delivery rate was higher in the Ritodrine group (70.7% vs. 60.1%, p<0.001). The number needed to treat to benefit was 10. In a multivariate analysis, Ritodrine was independently associated with higher ECV success rates as compared with Salbutamol (aOR 2.1, 95%CI 1.52-2.89). CONCLUSIONS Intramuscular ritodrine significantly improved the success rate of ECV compared to SC salbutamol, and both drugs were safe and acceptable before ECV.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel -
| | - Tal Cahan
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Tel-Aviv University, Tel-Aviv, Israel
| | - Yishay Weill
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michal Axelrod
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Tel-Aviv University, Tel-Aviv, Israel
| | - Raphael N Pollack
- Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Tel-Aviv University, Tel-Aviv, Israel
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Shinmura H, Matsushima T, Okuda N, Watanabe A, Nagashima A, Yamada M, Harigane E, Tsunoda Y, Ichikawa G, Suzuki S. Cephalic version by postural management in the lateral position without the knee-chest position for primiparous breech presentation: A retrospective cohort study. J Obstet Gynaecol Res 2022; 48:703-708. [PMID: 34994031 DOI: 10.1111/jog.15149] [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: 10/07/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to determine the efficacy of postural management in the lateral position for primiparous breech presentation. METHODS A retrospective cohort study was conducted at a single institution from January 2020 through December 2020. Participants were singleton primiparous pregnant women diagnosed with breech presentation between 28 + 0 and 29 + 6 weeks of gestation. The exclusion criteria were scheduled cesarean delivery, uterine malformation, transverse position, and scheduled delivery at another hospital. A doctor instructed the women in the intervention group to lie on their right sides several times a day if the fetal back was on the left side or lie on their left sides if the fetal back was on the right side. The knee-chest position and other methods were not recommended. The control group received expectant management care. The primary endpoint was the percentage of fetuses in a cephalic presentation 2 weeks later. RESULTS Of the 56 women included in the study, 17 women were instructed to lie in the lateral position, and 39 women received expectant management care only. After 2 weeks, women who were instructed to lie in lateral position had a higher rate of fetal cephalic version than the control group (82.4% [14/17] vs. 43.6% [17/39], p = 0.017). No study participants experienced adverse effects. CONCLUSIONS Two weeks of postural management in the lateral position without the knee-chest position significantly reduced the rate of primiparous breech presentation in the third trimester of pregnancy.
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Affiliation(s)
- Hiroki Shinmura
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Takashi Matsushima
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Naofumi Okuda
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Asako Watanabe
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Asako Nagashima
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Mayu Yamada
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Eika Harigane
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Youhei Tsunoda
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Go Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
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Zielbauer AS, Louwen F, Jennewein L. External cephalic version at 38 weeks' gestation at a specialized German single center. PLoS One 2021; 16:e0252702. [PMID: 34460836 PMCID: PMC8405029 DOI: 10.1371/journal.pone.0252702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Cesarean section (CS) rates are increasing worldwide. One constant indication is the breech presentation at term. By offering external cephalic version (ECV) and vaginal breech delivery CS rates can be further reduced. Objective This study aimed to analyze the ECV at 38 weeks of gestation with the associate uptake rate, predicting factors, success rate, and complications at a tertiary healthcare provider in Germany specializing in vaginal breech delivery. Methods We conducted a prospective cohort study with retrospective data acquisition. All women with a singleton fetus in breech presentation presenting after 34 weeks of gestation for counseling between 2013 and 2017 were included. ECV impact factors were analyzed using logistic regression. Results A total of 1,598 women presented for breech birth planning. ECV was performed on 353 patients. The overall success rate was 22.4%. A later week of gestation (odds ratio [OR] 1.69), an abundant amniotic fluid index (AFI score) (OR 5.74), fundal (OR 3.78) and anterior (OR 0.39) placental location, and an oblique lie (OR 9.08) were significantly associated with successful ECV in our population. No major complications were observed. The overall vaginal delivery rates could be increased to approximately 14% with ECV. Conclusion The demand for alternative birth modes other than CS for breech birth is high in the area of Frankfurt, Germany. Our study offers evidence of the safety of ECV at 38 weeks. Centers with expertise in vaginal breech delivery and ECV can reduce CS-rates. To further establish vaginal breech delivery and ECV as alternate options, the required knowledge and skill should be implemented in the revised curricula.
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Affiliation(s)
- Ann-Sophie Zielbauer
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Frankfurt, Germany
- * E-mail:
| | - Frank Louwen
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Frankfurt, Germany
| | - Lukas Jennewein
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Frankfurt, Germany
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Felemban AS, Arab K, Algarawi A, Abdulghaffar SK, Aljahdali KM, Alotaifi MA, Bafail SA, Bakhudayd TM. Assessment of the Successful External Cephalic Version Prognostic Parameters Effect on Final Mode of Delivery. Cureus 2021; 13:e16637. [PMID: 34458042 PMCID: PMC8384386 DOI: 10.7759/cureus.16637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/25/2022] Open
Abstract
Aim This study aims to evaluate the prognostic parameters of successful approach for an external cephalic version (ECV) procedure by considering the vaginal delivery as the optimal mode of delivery. Methodology A retrospective cohort study was done during June 2019 in the obstetrics and gynecology department at King Abdulaziz University Hospital. Data were collected between May 2009 and May 2019 and included all pregnant women who were candidates for the ECV. The primary objective was to assess the final mode of delivery in relation to the outcome of ECV followed by the secondary objective which was the prognostic parameters of the ECV procedure (body mass index, amniotic fluid index, parity, estimated fetal weight). Additional variables were maternal age, placental position and ethnicity. Results We have studied 86 pregnant women with ECV attempts the overall ECV success rate was for 46 women (59.7%). For the final mode of delivery, after a successful ECV procedure, 40 women (87%) whom had spontaneous vaginal delivery, in association to successful ECV, the prognostic parameters recorded the highest success rate were multiparous 35 (76.1%), body mass index between 25 and 29.9 (53.1%), women older than 30 years old (60.9%), gestational age between 37 to 39.6 weeks (56.5%). Posterior placental location 55.6%, estimated fetal weight more than 2500 (73.9%). Conclusion Successful ECV cases have recorded a significant increase in the incidence of spontaneous vaginal delivery and the outcome of ECV which is affected by many prognostic parameters such as parity, maternal age, gestational age, body mass index, amniotic fluid index (AFI) and estimated fetal weight (EFW).
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Affiliation(s)
| | - Kholoud Arab
- Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Asmaa Algarawi
- Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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Successful Vaginal Delivery after External Cephalic Version in a Woman with a Large Partial Uterine Septum. Case Rep Obstet Gynecol 2021; 2021:9912271. [PMID: 34104501 PMCID: PMC8159644 DOI: 10.1155/2021/9912271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/03/2022] Open
Abstract
Septate uteri have been associated with adverse pregnancy outcomes including spontaneous abortion, preterm delivery, and malpresentation. It is unclear if uterine septa are associated with infertility. Although some studies have shown improved pregnancy outcomes after septum resection, indications for resection are not well established. We describe a case of a woman with a large partial uterine septum diagnosed during workup for infertility who conceived without septum resection. Both of her subsequent pregnancies were initially breech presentations for which the patient underwent external cephalic version followed by full-term vaginal deliveries. This case adds evidence that an unresected uterine septum should not be considered a contraindication to external cephalic version.
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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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Levin G, Ezra Y, Weill Y, Kabiri D, Pollack RN, Rottenstreich A. Nifedipine versus ritodrine during external cephalic version procedure: a case control study. J Matern Fetal Neonatal Med 2019; 34:3008-3013. [PMID: 31608725 DOI: 10.1080/14767058.2019.1677589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Published series regarding interventions for facilitating external cephalic version (ECV) have concluded that parenterally administered beta-stimulant tocolytics, increased ECV success rate and reduced the number of cesarean sections. However, there were insufficient data regarding calcium channel blockers to provide good evidence regarding its efficacy. Given the paucity of literature, we aimed to compare the efficacy of nifedipine to that of ritodrine on ECV success rates. METHODS This is a retrospective case control study of prospectively collected data of patients who underwent ECV between January 2012 and December 2013 at Bikur Cholim Medical Center and Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Patient undergoing ECV with tocolysis by ritodrine were compared with those using nifedipine as tocolysis. Patients were matched in a one-to-one ration by parity and placental location. RESULTS Overall, 148 women received ritodrine and 148 women received nifedipine before ECV procedure. Overall success rate was higher among the ritodrine group (82.4 vs. 63.5%, p < .001). Among nulliparous and among parous, success rate was higher in the ritodrine group (78.9 vs. 57.9 and 88.6 vs. 73.5%, p = .001, p = .04, respectively). Vaginal delivery rate was higher among the ritodrine group (86.5 vs. 68.9%, p < .001). Cesarean delivery rate was 31.1% for the nifedipine group versus 13.5% in the ritodrine group (p < .001). Number needed to treat to benefit (NNTb) 5.7 (95% confidence interval 3.7-12.1). Overall, 216 of 296 (72.9%) of ECV were successful. Ritodrine was associated with higher success rates as compared with nifedipine (56.5 vs. 32.5%, p < .001). In a multivariate analysis, ritodrine tocolytic therapy was independently associated higher ECV success rates as compared to nifedipine (OR 4.54, 95% CI 2.38-9.09). Higher amniotic fluid index (OR 1.16, 95% CI 1.05-1.28) and nulliparity (OR 0.16, 95% CI 0.08-0.30) were additional independent predictors of ECV outcome. CONCLUSION Ritodrine significantly improve the success of ECV compared with nifedipine. Both drugs are shown to be safe.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yishay Weill
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Raphael N Pollack
- Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Late preterm versus term external cephalic version: an audit of a single obstetrician experience. Arch Gynecol Obstet 2019; 300:875-880. [DOI: 10.1007/s00404-019-05244-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
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