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Cobec IM, Varzaru VB, Kövendy T, Kuban L, Eftenoiu AE, Moatar AE, Rempen A. External Cephalic Version-A Chance for Vaginal Delivery at Breech Presentation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1619. [PMID: 36363576 PMCID: PMC9693153 DOI: 10.3390/medicina58111619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 03/14/2024]
Abstract
Background and Objectives: In recent years, the rate of caesarean section (CS) has increased constantly. Although vaginal breech delivery has a long history, breech presentation has become the third most common indication for CS. This study aims to identify factors associated with the success of external cephalic version (ECV), underline the success rate of ECV for breech presentation and highlight the high rate of vaginal delivery after successful ECV. Material and Methods: This retrospective observational study included 113 patients with singleton fetuses in breech presentation, who underwent ECV from January 2016 to March 2021 in the Clinic of Obstetrics and Gynecology, Diakonieklinikum Schwäbisch Hall, Germany. Maternal and fetal parameters and data related to procedure and delivery were collected. Possible predictors of successful ECV were evaluated. Results: The success rate of ECV was 54.9%. The overall rate of vaginal birth was 44.2%, regardless of ECV outcome. The vaginal birth rate after successful ECV was 80.6%. Overall, 79.0% of women with successful ECV delivered spontaneously without complications, 19.4% delivered through CS performed during labor by medical necessity, and 1.6% delivered through vacuum extraction. ECV was performed successfully in three of the four women with history of CS. Gravidity, parity, maternal age, gestational age, fetal weight, and amniotic fluid index (AFI) were significantly correlated with the outcome of ECV. Conclusions: ECV for breech presentation is a safe procedure with a good success rate, thus increasing the proportion of vaginal births. Maternal and fetal parameters can be used to estimate the chances of successful ECV.
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Affiliation(s)
- Ionut Marcel Cobec
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Vlad Bogdan Varzaru
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Tamas Kövendy
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Lorant Kuban
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
| | - Anca-Elena Eftenoiu
- Clinic of Internal Medicine, Hohenloher Krankenhaus Öhringen, 74613 Öhringen, Germany
| | | | - Andreas Rempen
- Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany
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Vaginal Delivery After External Cephalic Version in Patients With a Previous Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol 2020; 136:965-971. [PMID: 33030882 DOI: 10.1097/aog.0000000000004065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To estimate the rate of vaginal delivery after successful external cephalic version for breech presentation in women with compared with without a previous cesarean birth. DATA SOURCES We searched MEDLINE, Scopus, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the mode of delivery after successful external cephalic version in women with and without a previous cesarean birth. METHODS OF STUDY SELECTION Two reviewers independently identified studies, extracted data, and evaluated study quality. The rate of vaginal delivery after successful external cephalic version in women with and without a previous cesarean birth was compared, and odds ratios (ORs) with 95% CIs were estimated. TABULATION, INTEGRATION, AND RESULTS Six cohort studies and two case-control studies, reporting on 14,515 women were identified. The median point prevalence of a successful external cephalic version was 74% (interquartile range 63-81%) in women with a previous cesarean birth compared with 69% (interquartile range 64-83%) in women without a previous cesarean birth. The overall success rate of external cephalic version in women with a previous cesarean birth was similar compared with women without a previous cesarean birth (pooled OR 0.84, 95% CI 0.61-1.15). The median point prevalence of a vaginal delivery was 75% (interquartile range 61-84%) in women with a previous cesarean birth compared with 92% (interquartile range 85-95%) in women without a previous cesarean birth after a successful external cephalic version. The overall success rate of a vaginal delivery in women with a previous cesarean birth was less compared with women without a previous cesarean birth (pooled OR 0.26, 95% CI 0.14-0.50). A planned subgroup analysis on studies that included only multiparous women in the control group (parity one or greater) noted the overall success rate of external cephalic version in women with a previous cesarean birth 76% (853/1,123) was lower compared with multiparous women without a previous cesarean birth 84% (9,911/11,855) (pooled OR 0.70, 95% CI 0.54-0.89, I 37%). The overall success rate of a vaginal delivery in women with a previous cesarean birth 83% (666/806) was less compared with women without a previous cesarean birth 97% (9,449/9,746) (pooled OR 0.21, 95% CI 0.12-0.39, I 73%). CONCLUSION Women with previous cesarean birth have similar rates of successful external cephalic version when compared with women without a cesarean birth. Although the rate of vaginal delivery is lower, the majority of patients have a successful vaginal birth after cesarean. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020160145.
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Abstract
In the United States, there is a widespread belief that the overall cesarean birth rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean birth, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.
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McLaren R, Atallah F, Fisher N, Minkoff H. Correlation of Obesity with External Cephalic Version Success among Women with One Previous Cesarean Delivery. AJP Rep 2020; 10:e324-e329. [PMID: 33094023 PMCID: PMC7571570 DOI: 10.1055/s-0040-1715173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/13/2020] [Indexed: 10/26/2022] Open
Abstract
Objective Our aim was to assess the correlation of body mass index (BMI) with the success rate of external cephalic version (ECV) among women with one prior cesarean delivery. Study Design A cross-sectional study of pregnant women with one previous cesarean delivery who underwent ECV. The relationship between BMI and success rate of ECV was assessed. Adverse outcomes were also compared between women with an ECV attempt, and women who had a repeat cesarean delivery. Data were extracted from the U.S. Natality Database from 2014 to 2017. Pearson's correlation coefficient was performed to assess the relationship between BMI and success rate of ECV. Results There were 2,329 women with prior cesarean delivery underwent an ECV attempt. The success rate of ECV among the entire cohort was 68.3%. There was no correlation between BMI and success rate of ECV ( r = 0.024, p = 0.239). Risks of adverse maternal and neonatal outcomes were similar between the ECV attempt group and the repeat cesarean delivery group. Conclusion There was no correlation of BMI with the rate of successful ECV among women with one prior cesarean delivery. Given the similar success rates of ECV and adverse outcomes, obese women with one prior cesarean delivery should be offered ECV.
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Affiliation(s)
- Rodney McLaren
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Nelli Fisher
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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External cephalic version after previous cesarean section: A cohort study of 100 consecutive attempts. Eur J Obstet Gynecol Reprod Biol 2018; 231:210-213. [PMID: 30412904 DOI: 10.1016/j.ejogrb.2018.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/03/2018] [Accepted: 10/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE External cephalic version is commonly not performed in women with a previous cesarean section. Fear of uterine rupture and cesarean section in labor are prominent. The risks, however, of these are unclear. This study aims to document the safety and efficacy of external cephalic version in women with a prior cesarean section in a series of 100 consecutive attempts, and to perform a literature of the existing literature. STUDY DESIGN This is a retrospective cohort study of prospectively collected data of external cephalic version attempts in women at term with a previous cesarean section, and a literature review of previously published series. External cephalic version was performed by one of 3 experienced operators, with salbutamol tocolysis if appropriate, using ultrasound to visualize the fetal heart and place of fetal parts. RESULTS 100 women with a prior cesarean section underwent external cephalic version over a 16-year period in one institution. 68% had no previous vaginal delivery. The external cephalic version success rate was 50%, and 30 (63.8%) of these subsequently delivered vaginally. There were no cases of uterine rupture or other complications. A literature review of series containing a total of 549 cases revealed no cases of uterine rupture or perinatal death. CONCLUSIONS External cephalic version in women with a prior cesarean section is safe but enables a vaginal birth in only about a third of women.
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McLaren RA, Atallah F, Fisher N, Minkoff H. Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery. AJP Rep 2018; 8:e349-e354. [PMID: 30574429 PMCID: PMC6261738 DOI: 10.1055/s-0038-1676297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2018] [Indexed: 11/07/2022] Open
Abstract
Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% ( p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17-5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19-21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10-2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.
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Affiliation(s)
- Rodney A McLaren
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Nelli Fisher
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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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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Keepanasseril A, Anand K, Soundara Raghavan S. Matched cohort study of external cephalic version in women with previous cesarean delivery. Int J Gynaecol Obstet 2017; 138:79-83. [DOI: 10.1002/ijgo.12169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/19/2017] [Accepted: 04/03/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Keerthana Anand
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Subrahmanian Soundara Raghavan
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
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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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Burgos J, Cobos P, Rodríguez L, Osuna C, Centeno MM, Martínez-Astorquiza T, Fernández-Llebrez L. Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. BJOG 2013; 121:230-5; discussion 235. [DOI: 10.1111/1471-0528.12487] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J Burgos
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - P Cobos
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - L Rodríguez
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - C Osuna
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - MM Centeno
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - T Martínez-Astorquiza
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - L Fernández-Llebrez
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
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Schmitz T. Situations cliniques particulières, maternelles ou fœtales, influençant le choix du mode d’accouchement en cas d’antécédent de césarienne. ACTA ACUST UNITED AC 2012; 41:772-81. [DOI: 10.1016/j.jgyn.2012.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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ROSMAN AGEETHN, GUIJT ALINE, VLEMMIX FLOORTJE, RIJNDERS MARLIES, MOL BENWJ, KOK MARJOLEIN. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand 2012; 92:137-42. [DOI: 10.1111/aogs.12011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Outcome of external cephalic version in breech presentation. Med J Armed Forces India 2012; 68:151-3. [PMID: 24669057 DOI: 10.1016/s0377-1237(12)60036-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 12/20/2011] [Indexed: 11/21/2022] Open
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Burgos J, Melchor JC, Pijoán JI, Cobos P, Fernández-Llebrez L, Martínez-Astorquiza T. A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term. Int J Gynaecol Obstet 2010; 112:48-51. [PMID: 20870233 DOI: 10.1016/j.ijgo.2010.07.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 06/27/2010] [Accepted: 08/24/2010] [Indexed: 11/27/2022]
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Current world literature. Curr Opin Anaesthesiol 2010; 23:283-93. [PMID: 20404787 DOI: 10.1097/aco.0b013e328337578e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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