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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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Birene B, Ishaque U, Chrusciel J, Bonneau S, Gabriel R, Graesslin O. Influence of the external cephalic version attempt on the Cesarean section rate: experience of a type 3 maternity hospital in France. Arch Gynecol Obstet 2020; 303:443-454. [PMID: 32895742 DOI: 10.1007/s00404-020-05765-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To define the effects of attempted external cephalic version (ECV) in a low-risk population for breech delivery in a maternity hospital where breech vaginal delivery is widely practiced. MATERIALS AND METHODS Retrospective exposed-unexposed study including 204 patients presented with a live singleton fetus breech presentation on third-trimester ultrasound and who delivered at Reims University Hospital between January 1st, 2013 and July 1st, 2018. RESULTS 121 patients received ECV. Cesarean section rate was lower (OR with no adjustment 0.42 [0.24-0.76] p = 0.004) but without significant difference in the exposed patients after adjustment. This difference was significant between exposed and unexposed patients in the subgroup of 51 primiparous (OR = 0.14 [0.04-0.52] p = 0.002) and 51 multiparous (OR = 0.26 [0.08-0.89] p = 0.028) but not in the subgroup of 102 nulliparous. There was no difference in fetal impact other than neonatal management in the delivery room, which is less needed in exposed primiparous women. Attempted ECV significantly decreased the breech rate (72.5 vs 100%, p < 0.001). There were 7 (5.79%) complications. Three factors favored success: high uterine height (p = 0.011), a non-elevated BMI (p = 0.006) and an earlier term at ECV (p = 0.003). CONCLUSION The attempt of ECV in the Reims University Hospital does not significantly reduce the Cesarean section rate and has no effect on neonatal status.
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Affiliation(s)
- Benjamin Birene
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France.
| | - U Ishaque
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
| | - J Chrusciel
- Department of Research and Public Health, Reims University Hospital, Reims, France
| | - S Bonneau
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
| | - R Gabriel
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
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Barbash-Hazan S, Nattiv N, Salzer-Sheelo L, Bergel R, Hadar E, Osovsky M, Shmueli A. Induction of labor versus expectant management after successful external cephalic version. Birth 2019; 46:623-627. [PMID: 31612564 DOI: 10.1111/birt.12458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND External cephalic version (ECV) is a common procedure for women carrying a breech-presenting fetus, in an effort to avoid a cesarean birth. The benefit of immediate labor induction after ECV vs. expectant management is undetermined. We aimed to evaluate whether induction of labor immediately after a successful ECV improves the chances of a vaginal delivery compared with expectant management. METHODS Retrospective analysis of 296 women who underwent successful ECV performed in term singleton gestations (2007-2018) in the Rabin Medical Center. Mode of delivery and other obstetrical and neonatal outcomes were compared between women undergoing immediate labor induction after ECV and those managed expectantly. RESULTS Of 296 women after successful ECVs, 54 (18.2%) underwent immediate labor induction and 242 (81.8%) were managed expectantly. Immediate induction was associated with higher parity (2.4 vs 1.7, P = .03) and lower mean birthweight (3128 vs 3346 g, P < .01). Mode of delivery was similar between groups, and no other significant differences in obstetrical and neonatal adverse outcomes were noted. DISCUSSION In our cohort, immediate labor induction after successful ECV apparently had no benefits in terms of obstetrical or neonatal complications, and did not reduce the risk of cesarean birth. Therefore, expectant management seems reasonable and safe.
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Affiliation(s)
- Shiri Barbash-Hazan
- Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noga Nattiv
- Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Salzer-Sheelo
- Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riki Bergel
- Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micky Osovsky
- Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Induction du travail après une version par manœuvres externes pour siège réussie : un sur-risque de césarienne? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1031-1037. [PMID: 29887362 DOI: 10.1016/j.jogc.2017.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effect of successful external cephalic version (ECV) on the risk of caesarean section (CS) during attempted vaginal delivery after induction of labour. METHODS A unicentric matched retrospective observational case-control cohort study with exposed and unexposed groups. All pregnant women who had an induction of labour after a successful external cephalic version (sECV) between 1998 and 2016 were included. A total of 88 cases were compared with 176 controls (spontaneous cephalic presentation), matching for the year of delivery, parity, gestational age, indication and mode of induction of labour. The main outcome measure was the risk of caesarean. A univariate analysis and a multivariate logistic regression analysis were performed. RESULTS The caesarean section rate was significantly higher after sECV (22% versus 13.1%; p = 0.039) especially for postdate pregnancy (55% versus 8.2%; p <0.05). For the univariate analysis, age (31 years and 4 months versus 24 years and 6 months; p <0.01) and maximal speed of oxytocin infusion (72 ml/h versus 68 ml/h; p = 0.04) were higher in the case group. The multivariate analysis showed that the risk of caesarean section was significantly increased after an sECV (aOR 1.946; 95% CI 1.017-3.772) and after the use of prostaglandins for ripening (aOR 1.951; 95% CI 1.097-3.468), and decreased for multipara (aOR 0.208; 95% CI 0.114-0.377). CONCLUSION Women who have a successful ECV are at increased risk of caesarean section after subsequent induction of labour.
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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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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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Yamasato K, Kaneshiro B, Salcedo J. Neuraxial blockade for external cephalic version: Cost analysis. J Obstet Gynaecol Res 2015; 41:1023-31. [PMID: 25771920 PMCID: PMC5637526 DOI: 10.1111/jog.12674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 12/05/2013] [Indexed: 11/30/2022]
Abstract
AIM Neuraxial blockade (epidural or spinal anesthesia/analgesia) with external cephalic version increases the external cephalic version success rate. Hospitals and insurers may affect access to neuraxial blockade for external cephalic version, but the costs to these institutions remain largely unstudied. The objective of this study was to perform a cost analysis of neuraxial blockade use during external cephalic version from hospital and insurance payer perspectives. Secondarily, we estimated the effect of neuraxial blockade on cesarean delivery rates. METHODS A decision-analysis model was developed using costs and probabilities occurring prenatally through the delivery hospital admission. Model inputs were derived from the literature, national databases, and local supply costs. Univariate and bivariate sensitivity analyses and Monte Carlo simulations were performed to assess model robustness. RESULTS Neuraxial blockade was cost saving to both hospitals ($30 per delivery) and insurers ($539 per delivery) using baseline estimates. From both perspectives, however, the model was sensitive to multiple variables. Monte Carlo simulation indicated neuraxial blockade to be more costly in approximately 50% of scenarios. The model demonstrated that routine use of neuraxial blockade during external cephalic version, compared to no neuraxial blockade, prevented 17 cesarean deliveries for every 100 external cephalic versions attempted. CONCLUSIONS Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate.
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MESH Headings
- Adult
- Analgesia, Epidural/adverse effects
- Analgesia, Epidural/economics
- Analgesia, Obstetrical/adverse effects
- Analgesia, Obstetrical/economics
- Anesthesia, Epidural/adverse effects
- Anesthesia, Epidural/economics
- Anesthesia, Obstetrical/adverse effects
- Anesthesia, Obstetrical/economics
- Anesthesia, Spinal/adverse effects
- Anesthesia, Spinal/economics
- Breech Presentation/economics
- Breech Presentation/surgery
- Cesarean Section/adverse effects
- Cesarean Section/economics
- Cost Savings
- Costs and Cost Analysis
- Decision Support Systems, Clinical
- Decision Trees
- Female
- Hospital Costs
- Humans
- Insurance, Health, Reimbursement
- Nerve Block/adverse effects
- Nerve Block/economics
- Pregnancy
- United States
- Version, Fetal/adverse effects
- Version, Fetal/economics
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Affiliation(s)
- Kelly Yamasato
- Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology, and Women's Health, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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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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Hants Y, Kabiri D, Elchalal U, Arbel-Alon S, Drukker L, Ezra Y. Induction of labor at term following external cephalic version in nulliparous women is associated with an increased risk of cesarean delivery. Arch Gynecol Obstet 2015; 292:313-9. [DOI: 10.1007/s00404-015-3643-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
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Route of delivery following successful external cephalic version. Int J Gynaecol Obstet 2014; 126:272-4. [DOI: 10.1016/j.ijgo.2014.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/20/2014] [Accepted: 05/07/2014] [Indexed: 11/22/2022]
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Kuppens SM, Hutton EK, Hasaart TH, Aichi N, Wijnen HA, Pop VJ. Mode of Delivery Following Successful External Cephalic Version: Comparison With Spontaneous Cephalic Presentations at Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:883-888. [DOI: 10.1016/s1701-2163(15)30809-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vlemmix F, Kuitert M, Bais J, Opmeer B, van der Post J, Mol BW, Kok M. Patient's willingness to opt for external cephalic version. J Psychosom Obstet Gynaecol 2013; 34:15-21. [PMID: 23394409 DOI: 10.3109/0167482x.2012.760540] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE External cephalic version (ECV) is a relatively simple and safe maneuver that reduces the cesarean section (CS) rate for breech presentation. There is professional consensus that ECV should be offered to all women, but only up to 70% of patients opt for this treatment. To improve counseling, we investigated the value patients place on various aspects of ECV. METHODS We studied patient preferences by means of a vignette study. Varying levels of treatment characteristics were investigated in 16 scenarios, all including the "opt out" alternative of an elective CS. The probability that women preferred ECV was estimated using a logistic regression approach. RESULTS Forty seven women participated in the study. Pain was the most important factor negatively influencing the willingness to opt for ECV (OR 0.11 (95% confidence interval (CI) 0.05-0.23) for a pain score of 8-10 compared to 1-2 on a visual analog scale of 0-10). Higher success rates of vaginal delivery after successful ECV increased women's willingness (OR 3.42 (95% CI 2.04-5.74), if chance of vaginal delivery after successful ECV increased from 24% to 52%). The risk of an emergency CS during ECV did not influence the willingness to opt for ECV (OR 0.83 (95% CI 0.59-1.18) of chance increased from 0% to 1%). CONCLUSIONS We conclude that expected pain during treatment and the success rate are the most important factors influencing the willingness to undergo ECV. Taking this information into account when counseling for ECV and reassuring women that unbearable pain is always a reason to stop ECV, and that the vast majority of women reported that the experienced pain is bearable, might improve the uptake of ECV and decrease the number of CS due to breech presentation.
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Affiliation(s)
- Floortje Vlemmix
- Department of Obstetrics and Gynecology, AMC, Amsterdam, the Netherlands.
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Guerra S, Lopez-Picado A, Muñoz H, Marín J, Lete I, Echevarria O. Versión cefálica externa en presentación de nalgas: una técnica ancestral muy actual. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sultan P, Carvalho B. Neuraxial blockade for external cephalic version: a systematic review. Int J Obstet Anesth 2011; 20:299-306. [PMID: 21925869 DOI: 10.1016/j.ijoa.2011.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/29/2011] [Accepted: 07/01/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version. METHODS A systematic literature review of studies that examined success rates of external cephalic version with neuraxial anesthesia was performed. Published articles written in English between 1945 and 2010 were identified using the Medline, Cochrane, EMBASE and Web of Sciences databases. RESULTS Six, randomized controlled studies were identified. Neuraxial blockade significantly improved the success rate in four of these six studies. A further six non-randomized studies were identified, of which four studies with control groups found that neuraxial blockade increased the success rate of external cephalic version. Despite over 850 patients being included in the 12 studies reviewed, placental abruption was reported in only one patient with a neuraxial block, compared with two in the control groups. The incidence of non-reassuring fetal heart rate requiring cesarean delivery in the anesthesia groups was 0.44% (95% CI 0.15-1.32). CONCLUSIONS Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version.
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Affiliation(s)
- P Sultan
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Timing of Delivery After External Cephalic Version and the Risk for Cesarean Delivery. Obstet Gynecol 2011; 118:209-213. [DOI: 10.1097/aog.0b013e31822545a9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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