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Londero AP, Xholli A, Massarotti C, Fruscalzo A, Cagnacci A. Factors influencing the effect of external cephalic version: a retrospective nationwide cohort analysis. Arch Gynecol Obstet 2023; 308:1127-1137. [PMID: 36068364 PMCID: PMC10435405 DOI: 10.1007/s00404-022-06763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/19/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aims to assess the factors associated with the success and failure rate of the external cephalic version (ECV) in breech fetuses. Secondary outcomes were fetal presentation in labor and mode of delivery. METHODS This cross-sectional study examined the live birth certificates from 2003 through 2020 from US states and territories that implemented the 2003 revision. A total of 149,671 singleton pregnancies with information about ECV success or failure were included. The outcome was ECV success/failure, while the exposures were possible factors associated with the outcome. RESULTS The successful ECV procedures were 96,137 (64.23%). Among the successful ECV procedures, the prevalence of spontaneous vaginal delivery was 71.63%. Among the failed ECV procedures, 24.74% had a cephalic presentation at delivery, but 63.11% of these pregnancies were delivered by cesarean section. Nulliparity, female sex, low fetal weight centile, high pre-pregnancy BMI, high BMI at delivery, and high maternal weight gain during pregnancy were associated with an increased ECV failure (p < 0.001). African American, American Indian and Alaska Native race categories were significant protective factors against ECV failure (p < 0.001). Maternal age had a U-shape risk profile, whereas younger maternal age (< 25 years) and old maternal age (> 40 years) were significant protective factors against ECV failure (p < 0.001). CONCLUSIONS A high prevalence of successful ECV procedures and subsequent spontaneous vaginal delivery were found. The present results found nulliparity, maternal race, maternal age, female fetal sex, low fetal weight, and maternal anthropometric features correlated to ECV results. These findings can potentially improve the knowledge about the factors involved in ECV, allowing more informed counseling to the women undergoing this procedure.
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Affiliation(s)
- Ambrogio P Londero
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy.
| | - Anjeza Xholli
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | - Claudia Massarotti
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | - Arrigo Fruscalzo
- Clinic of Obstetrics and Gynecology, University Hospital of Fribourg, Fribourg, Switzerland
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, IRCCS-Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
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Boujenah J, Fleury C, Bonneau C, Pharisien I, Tigaizin A, Carbillon L. Successful external cephalic version is an independent factor for caesarean section during trial of labor – a matched controlled study. J Gynecol Obstet Hum Reprod 2017; 46:737-742. [DOI: 10.1016/j.jogoh.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 09/04/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
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Predictors of Cephalic Vaginal Delivery Following External Cephalic Version: An Eight-Year Single-Centre Study of 447 Cases. Obstet Gynecol Int 2017; 2017:3028398. [PMID: 28512470 PMCID: PMC5420421 DOI: 10.1155/2017/3028398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction. Our study aims to investigate and evaluate (1) rates of success of ECV for breech presentation at term at the Royal Women's Hospital in comparison to international standards; (2) mode of delivery following ECV; (3) factors influencing success rates of ECV at the Royal Women's Hospital. Methods. An audit of all women who underwent ECV between the years 2007 and 2014 at the Royal Women's Hospital as public patients was completed. Data parameters were collected from paper and electronic patient files at the Women's Hospital. Data was collected to analyse the effect of the following parameters on ECV success and birth outcome: age, parity, gestational age, BMI, AFI, and tocolytic use. These parameters were analysed to determine their effect on ECV outcome and birth outcome. Results. The Women's Hospital, Melbourne, has an ECV success rate of approximately 37%. Of the patients undergoing ECV, 29% proceeded to normal vaginal delivery. Predictors of successful ECV included low BMI, multiparity, and AFI more than 16 (P < 0.05). The only predictor of cephalic vaginal delivery following ECV was multiparity. Negative predictors of cephalic delivery were low AFI and nulliparity. Conclusions. The success rate of ECV at the Women's Hospital, Melbourne, is in line with global standards.
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Pichon M, Guittier MJ, Irion O, Boulvain M. [External cephalic version in case of persisting breech presentation at term: motivations and women's experience of the intervention]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2013; 41:427-432. [PMID: 23102577 DOI: 10.1016/j.gyobfe.2012.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 04/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the efficacy and acceptability of external cephalic version (ECV). MATERIALS AND METHOD From 2004 to 2008, 212 pregnant women between 34-37 weeks of gestation with fetus in breech presentation were included in a randomized clinical trial and 125 externals cephalic versions were studied. RESULTS A success rate of 37.6%t was recorded. At 34 weeks of gestation, 80.6% of women were considering an ECV in the event of persistent breech position at 37 weeks. These women expressed the desire to give birth vaginally (52% versus 24.4%, P<0.001). In contrast, others women preferred an elective cesarean section to avoid the risk of a breech vaginal delivery. Women felt pain during the ECV and scored 60 on average using the analogical visual scale. Women rated on a verbal rating scale the ECV as severely painful to unbearable (68%), and as stressful (70%). Despite this, the majority of women would recommend ECV to their friends or would be willing to repeat it for themselves. DISCUSSION AND CONCLUSION ECV remains a scary and painful medical procedure. More research is needed to reduce the impact. The use of analgesic medication for this indication is controversial. Hypnosis could be an alternative to evaluate.
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Affiliation(s)
- M Pichon
- HEdS, 47, avenue de Champel, Genève, Suisse.
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Mukaindo AM, Wanyonyi SZ, Stones WR. External cephalic version in East, Central, and Southern Africa. Int J Gynaecol Obstet 2011; 116:228-31. [DOI: 10.1016/j.ijgo.2011.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/13/2011] [Accepted: 11/23/2011] [Indexed: 11/30/2022]
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SULLIVAN EA, MORAN K, CHAPMAN M. Term breech singletons and caesarean section: A population study, Australia 1991-2005. Aust N Z J Obstet Gynaecol 2009; 49:456-60. [DOI: 10.1111/j.1479-828x.2009.01050.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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