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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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Naert MN, Kishkovich TP, Warsame F, Taboada MP, James KE, Clapp MA, Barth WH. Role of individual physicians in success of external cephalic version. Am J Obstet Gynecol 2023; 229:347-349.e1. [PMID: 37247646 DOI: 10.1016/j.ajog.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Mackenzie N Naert
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.
| | - Thomas P Kishkovich
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
| | - Fowsia Warsame
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
| | - Mireya P Taboada
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
| | - Kaitlyn E James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
| | - Mark A Clapp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
| | - William H Barth
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
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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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4
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Palepu PM, Anand K, Ghosh SK, Keepanasseril A. Factors associated with intrapartum cesarean section after a successful external cephalic version. J Matern Fetal Neonatal Med 2021; 35:9038-9042. [PMID: 34882048 DOI: 10.1080/14767058.2021.2012652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE External cephalic version (ECV) is an effective procedure to reduce the breech presentation at term reducing the chances of cesarean section. However even after successful ECV reports suggests the risk of having a cesarean section is high. The study analyzes the mode of delivery after a successful ECV and to identify the factors associated with intrapartum cesarean delivery compared to those with spontaneous cephalic presentation. METHODS This study was based on labor and delivery details, from the ECV registers, of 430 women who had successful ECV and they compared to those with spontaneous cephalic presentation. Primary outcome was delivery by cesarean section. Multiple logistic regression model was used to assess independent association of frisk factors associated with intrapartum cesarean section delivery by cesarean section and were presented as Odds Ratio (OR) and 95% confidence interval. RESULTS Cesarean section rates were similar among those who had a successful ECV and those with spontaneous cephalic presentation (22.3% vs 20.1%, p = 0.298). Women who had a successful ECV (OR = 1.5; (95%CI 1.13-1.98), maternal age (OR1.06-1.03-1.09), and previous delivery by cesarean section (OR = 5.16 (95%CI; 1.88-14.16) were found to associated with intrapartum cesarean section after adjusting for other factors. CONCLUSION Women who had a successful ECV had an increased risk of intrapartum cesarean section compared those women with spontaneous cephalic presentation. Further research should be performed to identify more risk factors, which could optimize intra-partum care to reduce the risk of cesarean section for women after successful ECV.
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Affiliation(s)
- Pavani Manikya Palepu
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Keerthana Anand
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Sunabha K Ghosh
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Svensson E, Axelsson D, Nelson M, Nevander S, Blomberg M. Success rate of external cephalic version in relation to the woman's body mass index and other factors-a population-based cohort study. Acta Obstet Gynecol Scand 2021; 100:2260-2267. [PMID: 34622950 DOI: 10.1111/aogs.14270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of women's body mass index (BMI) on the probability of a successful external cephalic version (ECV). MATERIAL AND METHODS A retrospective population-based observational study including all women that underwent an ECV in the southeast region of Sweden from January 2014 to December 2019. Data were collected from electronic medical records, Obstetrix, Cerner. The women were divided into BMI categories according to the World Health Organization classification. Women with a BMI below 25 kg/m2 formed the reference group. Crude and adjusted odds ratios for unsuccessful ECV in each BMI group were calculated using binary logistic regression. Furthermore, the association between maternal characteristics and clinical and ultrasound variables at the time of the ECV and unsuccessful ECV was evaluated. RESULTS A total of 2331 women were included. The overall success rate of ECV was 53.4%. Women with a BMI below 25 kg/m2 had a success rate of 51.3% whereas obese women had a success rate of 58.6%. The risk of an unsuccessful ECV among obese women (BMI ≥30 kg/m2 ) had an OR of 0.74 (95% CI 0.59-0.94) compared with women with a BMI below 25 kg/m2 . After adjusting for suitable confounding factors, the association was no longer significant. Higher maternal age, multiparity, higher gestational age, posterior placenta position, polyhydramnios and higher estimated weight of the fetus at the ECV significantly decreased the risk of an unsuccessful ECV. CONCLUSIONS Maternal obesity does not seem to negatively influence the success rate of ECV. This is a finding that may encourage both caregivers and obese pregnant women to consider an ECV and so avoid a planned cesarean section for breech presentation in this group.
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Affiliation(s)
- Emelie Svensson
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniel Axelsson
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden
| | - Marie Nelson
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sofia Nevander
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Norrköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Youssef A, Brunelli E, Fiorentini M, Lenzi J, Pilu G, El-Balat A. Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:609-615. [PMID: 33847431 DOI: 10.1002/uog.23649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA). METHODS Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra- and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using Bland-Altman analysis. Student's t-test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements. RESULTS Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80-0.93) and 0.83 (95% CI, 0.71-0.90), respectively. The mean difference between measurements was 0.4° (95% CI, -1.4 to 2.2°) for intraobserver repeatability and -0.4° (95% CI, -2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9-15.1°) and 13.6° (95% CI, 9.9-17.3°) for intra- and interobserver repeatability, respectively. The lower limits of agreement were -11.2° (95% CI, -14.3 to -8.1°) and -14.4° (95% CI, -18.2 to -10.7°) for intra- and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra- or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- or interobserver reliability. CONCLUSIONS BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Fiorentini
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - A El-Balat
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
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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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Katz D, Riley K, Kim E, Beilin Y. Comparison of Nitroglycerin and Terbutaline for External Cephalic Version in Women Who Received Neuraxial Anesthesia: A Retrospective Analysis. Anesth Analg 2020; 130:e58-e62. [PMID: 30985380 DOI: 10.1213/ane.0000000000004155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
External cephalic version is a technique that decreases the need for cesarean delivery in patients with breech presentation. Several techniques exist to increase the success of external cephalic version; however, there are no studies comparing different tocolytics in patients who also received neuraxial anesthesia. We, therefore, performed a review of 198 patients who presented for external cephalic version and compared their success rates based on the tocolytic medication utilized. The external cephalic version success rate for patients who received terbutaline was significantly higher than for those who received nitroglycerin (N [%]: 57 [65.6] terbutaline group versus 40 [36.0] nitroglycerin group; P < .001).
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Affiliation(s)
- Daniel Katz
- From the *Department of Anesthesiology, Pain, and Perioperative Medicine, Icahn School of Medicine, New York, New York †Department of Internal Medicine, Northwell Health John T. Mather Memorial Hospital, Port Jefferson, New York ‡City University of New York School of Medicine, New York, New York §Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine, New York, New York
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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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Carrillo-Aguirre G, Dalmau-Bueno A, Campillo-Artero C, García-Altés A. Caesarean section trends in Catalonia between 2013 and 2017 based on the Robson classification system: A cross-sectional study. PLoS One 2020; 15:e0234727. [PMID: 32544171 PMCID: PMC7297373 DOI: 10.1371/journal.pone.0234727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/01/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In Catalonia caesarean rates have always been analysed as a single percentage. The objective is to estimate caesarean section rates using the Robson classification in publicly funded hospitals in Catalonia between 2013 and 2017, considering sociodemographic, institutional and obstetric characteristics. MATERIALS AND METHODS Cross-sectional population-based study in Catalonia including all women delivering within publicly funded hospitals between 2013-2017 (n = 210 020). The modified Robson classification distribution was estimated, the caesarean rate and the overall contribution, analysed for each year, and by confounders, through logistic regression models. RESULTS CS rates decreased steadily between 2013 and 2017 in Catalonia within publicly funded hospitals from 24.3% to 22.8% (cOR 0.92, 95% CI; 0.89 to 0.95). Once adjusted for changes in sociodemographic, institutional and obstetric characteristics the observed decline was even more pronounced (aOR 0.87, 95% CI; 0.84 to 0.90). Within the different groups of Robson once adjusted for confounders, groups 1+2 (aOR 0.88, 95% CI; 0.83 to 0.93), 3+4 (aOR 0.83, 95% CI; 0.78 to 0.89) and 10 (aOR 0.78, 95% CI; 0.68 to 0.90) presented a reduction in caesarean section rates, whereas group 5 showed no significant decrease (aOR 0.95, 95% CI; 0.87 to 1.03%). CONCLUSIONS The decrease in caesarean section rates in Catalonia is more pronounced when adjusted for known confounders, suggesting retrospective overutilization of caesarean section and percentages of (in)adequacy in the past. In any case, it remains above the recommended by experts. Further efforts should be made to achieve optimum rates, including improvement on obstetric data collection.
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Affiliation(s)
- Garazi Carrillo-Aguirre
- Master’s Degree Public Health, Pompeu Fabra University (UPF), Barcelona, Spain
- Department of Health, Health Evaluation and Quality Agency of Catalonia (AQuAS), Government of Catalonia, Barcelona, Catalonia, Spain
| | - Albert Dalmau-Bueno
- Department of Health, Health Evaluation and Quality Agency of Catalonia (AQuAS), Government of Catalonia, Barcelona, Catalonia, Spain
| | - Carlos Campillo-Artero
- Center for Research in Health and Economics, Pompeu Fabra University, IB-Salut, Barcelona, Spain
| | - Anna García-Altés
- Department of Health, Health Evaluation and Quality Agency of Catalonia (AQuAS), Government of Catalonia, Barcelona, Catalonia, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
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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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13
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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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14
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Nalam RL, Chinnachamy P, Emmanuel P. External Cephalic Version: A Dying Art Worth Reviving. J Obstet Gynaecol India 2018; 68:493-497. [PMID: 30416278 DOI: 10.1007/s13224-018-1090-z] [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: 06/30/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022] Open
Abstract
Purpose Breech presentation is the most common abnormal presentation occurring in 3-4% of all deliveries. Incidence of caesarean section for breech presentation has increased markedly in the last few decades. Attempting external cephalic version (ECV) reduces the chance of non-cephalic presentation at term, thus reducing the rate of caesarean sections. Methods Prospective study was conducted in secondary healthcare centre, in rural set-up from August 2013 to August 2015. A total of 52 patients were enrolled into the study. Results ECV was successful in 32 out of 52 patients with overall success of 61.5%. Out of the 32 successful ECVs, 24 patients delivered vaginally (75%) (p value 0.00), 6 patients delivered by caesarean section, and 2 patients were lost to follow-up. Transverse lie had 100% success rate for ECV (p value 0.005). Gravidity, placental position, gestational age and use of tocolytics did not influence the success rate of ECV. Most common problem observed during the procedure was abdominal discomfort. Conclusion ECV is a safe procedure with high percentage of patients delivering vaginally after successful version. Hence, acquiring skills in ECV should be considered mandatory in the postgraduate training of future obstetricians.
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Affiliation(s)
- Raj Lakshmi Nalam
- Department of Obstetrics and Gynaecology, RDT Hospital, Bathalapalli, Anantapur District, 515661 Andhra Pradesh India
| | - Priya Chinnachamy
- Department of Obstetrics and Gynaecology, Christian Fellowship Hospital, Oddanchatram, Tamil Nadu 624619 India
| | - Paul Emmanuel
- Department of Obstetrics and Gynaecology, Christian Fellowship Hospital, Oddanchatram, Tamil Nadu 624619 India
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15
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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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16
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Effect of Oral Hydration on External Cephalic Version at Term. J Obstet Gynecol Neonatal Nurs 2017; 46:686-695. [DOI: 10.1016/j.jogn.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 11/21/2022] Open
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17
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Basu A, Flatley C, Kumar S. Intrapartum intervention rates and perinatal outcomes following successful external cephalic version. J Perinatol 2016; 36:439-42. [PMID: 26796127 DOI: 10.1038/jp.2015.220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine intrapartum and perinatal outcomes following successful external cephalic version for breech presentation at term. STUDY DESIGN This was a retrospective cohort study of outcomes following successful external cephalic version in 411 women at an Australian tertiary maternity unit between November 2008 and March 2015. The study cohort was compared with a control group of 1236 women with cephalic presentation who underwent spontaneous labor. Intrapartum intervention rates and adverse neonatal outcomes were compared between both groups. RESULTS The success rate of external cephalic version (ECV) was 66.4%. The spontaneous vaginal delivery rate in the study cohort was 59.4% (224/411) vs 72.8% (900/1236) in the control cohort (P<0.001). Intrapartum intervention rates (emergency cesarean section (CS) and instrumental delivery) were higher in the ECV group (38% vs 27.2%, P<0.001). Rates of emergency CS for non-reassuring fetal status (9.5%, 39/411 vs 4.4%, 54/1236, P⩽0.001) and failure to progress (13.4%, 55/411 vs 4.1%, 51/1236, P<0.001) were higher in the study cohort. Neonatal outcomes were worse in the study cohort-Apgar score <7 at 5 min (2.2%, 9/411 vs 0.6%, 8/1236, P<0.001) and abnormal cord gases (8.5%, 35/411 vs 0.2%, 3/1236, P<0.001). Rates for resuscitation at birth and admission to the neonatal intensive care unit were higher in the study cohort (6.1% vs 4.1% and 1.9% vs 1.1%, respectively) but these were not statistically significant. CONCLUSION Labor following successful ECV is more likely to result in increased intrapartum intervention rates and poorer neonatal outcomes.
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Affiliation(s)
- A Basu
- Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
| | - C Flatley
- Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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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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19
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Burgos J, Iglesias M, Pijoan JI, Rodriguez L, Fernández-Llebrez L, Martínez-Astorquiza T. Probability of cesarean delivery after successful external cephalic version. Int J Gynaecol Obstet 2015; 131:192-5. [DOI: 10.1016/j.ijgo.2015.04.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/15/2015] [Accepted: 07/16/2015] [Indexed: 12/01/2022]
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20
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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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21
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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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