Cesarean delivery after successful external cephalic version of breech presentation at term in japanese population

Abstract Background Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose–response effect. We hypothesized that increasing the intrathecal bupivacaine dose would be associated with increased external cephalic version success. Methods We conducted a randomized, double-blind trial to assess the effect of four intrathecal bupivacaine doses (2.5, 5.0, 7.5, 10.0 mg) combined with fentanyl 15 μg on the success rate of external cephalic version for breech presentation. Secondary outcomes included mode of delivery, indication for cesarean delivery, and length of stay. Results A total of 240 subjects were enrolled, and 239 received the intervention. External cephalic version was successful in 123 (51.5%) of 239 patients. Compared with bupivacaine 2.5 mg, the odds (99% CI) for a successful version were 1.0 (0.4 to 2.6), 1.0 (0.4 to 2.7), and 0.9 (0.4 to 2.4) for bupivacaine 5.0, 7.5, and 10.0 mg, respectively (P = 0.99). There were no differences in the cesarean delivery rate (P = 0.76) or indication for cesarean delivery (P = 0.82). Time to discharge was increased 60 min (16 to 116 min) with bupivacaine 7.5 mg or higher as compared with 2.5 mg (P = 0.004). Conclusions A dose of intrathecal bupivacaine greater than 2.5 mg does not lead to an additional increase in external cephalic procedural success or a reduction in cesarean delivery.

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Cesarean delivery after successful external cephalic version of breech presentation at term

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2006.03.015 ◽

2006 ◽

Vol 93 (3) ◽

pp. 248-249 ◽

Cited By ~ 4

Author(s):

S. Matsuzaki ◽

K. Shimoya ◽

Y. Murata

Keyword(s):

Cesarean Delivery ◽

Breech Presentation ◽

External Cephalic Version

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Fetal Malpresentation in Pregnancy

10.2310/obg.19071 ◽

2020 ◽

Author(s):

Afshin Azimirad ◽

Errol R. Norwitz

Keyword(s):

Vaginal Delivery ◽

Medical Center ◽

Breech Presentation ◽

Obstetric Care ◽

External Cephalic Version ◽

Breech Delivery ◽

Advantages And Disadvantages ◽

Ultrasound Evaluation ◽

Elective Repeat Cesarean ◽

Anatomical Part

Fetal presentation refers to that anatomical part of the fetus that presents at the maternal pelvic inlet. The most common and most desirable fetal presentation is cephalic (head first). Any presentation other than cephalic is referred to as a malpresentation. Breech is the most common fetal malpresentation. The prevalence of breech presentation varies with gestational age (25% at 28 weeks and 3-5% of at term). Ultrasound evaluation is the gold standard for the diagnosis of fetal presentation. External cephalic version (ECV) refers to a series of manual manipulations designed to convert a malpresenting fetus to cephalic to promote vaginal delivery. There are two strategies around the timing of ECV; at 36-37 weeks and/or at or shortly after 39 weeks’ gestation. Each has advantages and disadvantages. Currently, most breech pregnancies at term are delivered by cesarean at 39 weeks prior to the onset of labor. Malpresentation is the second most common indication for planned cesarean (behind elective repeat cesarean). Vaginal delivery for a breech fetus at term should only be attempted if the mother is strongly motivated, if the obstetric care provider is experienced, and if the medical center has the requisite facilities to manage any and all complications. This review contains 3 figures, 2 tables, and 66 references. Keywords: fetal presentation, malpresentation, breech presentation, ultrasound evaluation, external cephalic version (ECV), cesarean delivery, vaginal breech delivery

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Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery

American Journal of Perinatology Reports ◽

10.1055/s-0038-1676297 ◽

2018 ◽

Vol 08 (04) ◽

pp. e349-e354 ◽

Cited By ~ 2

Author(s):

Rodney McLaren ◽

Fouad Atallah ◽

Nelli Fisher ◽

Howard Minkoff

Keyword(s):

Cesarean Delivery ◽

Retrospective Cohort ◽

Adverse Outcomes ◽

Neonatal Outcomes ◽

External Cephalic Version ◽

Multivariable Logistic Regression Analysis ◽

Success Rates ◽

Trial Of Labor ◽

Maternal And Neonatal Outcomes ◽

Previous Cesarean

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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External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

Obstetrics and Gynecology ◽

10.1097/aog.0b013e318166e905 ◽

2008 ◽

Vol 111 (3) ◽

pp. 776 ◽

Cited By ~ 2

Author(s):

Mladen Predanic

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Breech Presentation ◽

External Cephalic Version ◽

Spinal Analgesia ◽

Randomized Controlled ◽

Nulliparous Women

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Reduction of maternal and neonatal harm through prevention of the primary Cesarean section

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v85i2.2222 ◽

2016 ◽

Vol 85 (2) ◽

pp. 19-21

Author(s):

Andrew Welton

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Common Knowledge ◽

Multiple Pregnancy ◽

Expectant Management ◽

Breech Presentation ◽

Active Phase ◽

External Cephalic Version ◽

Second Stage ◽

Nulliparous Women

While there are clear life-saving indications for Cesarean section (C-section), rates of this procedure have seen a continued rise without a concomitant improvement in maternal or neonatal outcomes. There is some evidence that outcomes may actually be worse for low-risk C-sections versus vaginal delivery. However, this is not necessarily common knowledge for healthcare providers, and therefore, their patients. Measures to safely reduce the C-section rate target management of labour arrest and specific indications for progression to C-section. In the active phase of the first stage of labour, C-section should be considered only in cases of failure to progress after 4 hours of adequate uterine contraction, or 6 hours of inadequate contraction. In the second stage of labour, expectant management of 3 hours of pushing in nulliparous women and 2 hours in multiparous women is safe and appropriate. Furthermore, manual rotation and operative vaginal delivery in the second stage are reasonable alternatives to C-section. Expectant management is also appropriate for certain non-reassuring fetal heart rate tracings. In post-dates pregnancies, induction of labour reduces both rates of C-section and neonatal mortality. Finally, evidence supports the use of external cephalic version in breech presentation as well as a more conservative approach to suspected macrosomia and multiple pregnancy. Taken together, these measures target the most common indications for progression to C-section and can allow us to safely reduce the C-section rate. Educating patients and physicians on the risks of the procedure and reasonable alternatives can improve outcomes for mothers and neonates.

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Congenital complete heart block in pregnancy

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2018-0042 ◽

2018 ◽

Vol 35 (2) ◽

Author(s):

Nurul Iftida Basri ◽

Shuhaila Ahmad

Keyword(s):

Postpartum Period ◽

Heart Block ◽

Multidisciplinary Approach ◽

Complete Heart Block ◽

Breech Presentation ◽

Permanent Pacemaker ◽

External Cephalic Version ◽

Congenital Complete Heart Block ◽

Temporary Pacemaker ◽

In Pregnancy

Abstract Complete heart block (CHB) is infrequently encountered during pregnancy. Its management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist and neonatologist. It varies from conservative, temporary or permanent pacemaker (PPM) insertion (either during the antenatal, intrapartum or postpartum period). We present the case of a 30-year-old, gravida 2 para 1 at the 36-week period of amenorrhea (POA) with congenital CHB. She was asymptomatic throughout her pregnancy despite having a pulse rate between 40 and 50 beats per minute. She delivered a healthy boy via cesarean section due to breech presentation after a failed external cephalic version. A temporary pacemaker was inserted prior to delivery. However, she required permanent insertion of pacemaker during the postpartum period.

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