scholarly journals Current Approach for External Cephalic Version in Germany

2020 ◽  
Vol 80 (10) ◽  
pp. 1041-1047
Author(s):  
Fabian Kohls ◽  
Friederike Gebauer ◽  
Markus Flentje ◽  
Lars Brodowski ◽  
Constantin Sylvius von Kaisenberg ◽  
...  
Keyword(s):  
Success Rate ◽  
Online Survey ◽  
Standard Procedure ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Outpatient Basis ◽  
Cesarean Sections ◽  
International Guidelines ◽  
Emergency Cesarean ◽  
External Version

Abstract Introduction Fetal breech presentation at terms occurs in 3 – 6% of pregnancies. External cephalic version can reduce the number of cesarean sections and vaginal breech deliveries. Different approaches are used to carry out external cephalic version. This study looked at the different approaches used in Germany and compared the approach used with the recommendations given in German and international guidelines. Material and Methods An anonymized online survey of 234 hospitals in Germany was carried out in 2018. In addition to asking about hospital structures, questions also focused on how external version was carried out in practice (preparations, tocolysis, anesthetics, etc.), on relative and absolute contraindications and on the success rate. Results 37.2% of the hospitals approached for the survey participated in the study. Of these, 98.8% performed external version procedures. The majority of participating hospitals were university hospitals (26.4%) and maximum care hospitals (35.6%) with an average number of more than 2000 births per year (60.9%). External cephalic version is the preferred (61.7%) obstetrical procedure to deal with breech presentation, rather than vaginal breech birth or primary cesarean section. 45.8% of respondents carry out external version procedures on an outpatient basis, and 42.1% of hospitals perform the procedure as an inpatient intervention, especially from the 37th week of gestation. Prior to performing an external version procedure, 21.6% of surveyed institutions carry out a vaginal examination to evaluate possible fixation of the fetal rump. 95.5% of institutions used fenoterol for tocolytic therapy; the majority using it for continuous tocolysis (70.2%). 1 – 3 attempts at external version (8.4%) were usually carried out by a specific senior physician. In most cases, no analgesics were administered. The reported rate of emergency cesarean sections was very low. The most common indication for emergency C-section was pathological CTG (56,7%). The assessment of relative and absolute contraindications varied, depending on the surveyed hospital. 67.5% asked patients to empty their bladders before carrying out external version, while 10.8% carried out external version when the bladder was filled. The reported success rate was more than 45%. After successful version, only 14.8% of hospitals arranged for patients to wear an abdominal binder. For 32.4%, the decision to apply an abdominal binder was taken on a case-by-case basis. Conclusion The approach used in Germany to carry out external cephalic version is based on the (expired) German guideline on breech presentation. Based on the evidence obtained, a number of individual recommendations should be re-evaluated. More recent international guidelines could be useful to update the standard procedure.

scholarly journals External cephalic version at 36 weeks and its outcome

2017 ◽  
Vol 6 (10) ◽  
pp. 4602
Author(s):  
Deepika N. ◽  
Arun Kumar
Keyword(s):  
Caesarean Section ◽  
Success Rate ◽  
Caesarean Section Rate ◽  
Invasive Procedure ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Clinical Settings ◽  
Safe Procedure ◽  
Breech Delivery ◽  
Non Invasive

Background: External cephalic version (ECV) is well known non-invasive procedure done for the management of breech presentation but is not routinely practised by obstetricians in many clinical settings. The aim of the study was to assess the success rate of external cephalic version, labour outcome of pregnancy after successful ECV, to study maternal and foetal complications associated with ECV and to explore the reasons for failed ECV.Methods: It was a prospective interventional study to assess the labour outcomes of pregnancies with successful and uncomplicated ECV. All women who had singleton breech presentation at 36+ weeks were included unless contraindications for ECV were present. After obtaining consent, ECV was attempted after giving tocolysis.Results: The total number of deliveries was 6038 in the same period. Out of these 301 were breech presentations thus the incidence of breech presentation was 4.9%. ECV was offered to 81 women (26.9%) and out of these 77 women (95.06%) gave consent for the procedure. The remaining 4 (4.93%) did not give consent due to anxiety about the procedure. The success rate was 54.54%. Out of total 301 women with breech presentation 40 women (13.3%) had assisted breech delivery and 216 women (71.8%) had caesarean section due to obstetric indications. Thus the caesarean section rate for breech presentation at our institute was 71.8%. ECV was successful in 63.82% of the multigravida on which it was attempted as compared to 40% of the primigravida. The success rate of ECV in the present study is maximum when ECV was performed at a gestational age of 38-39 weeks and when fetal weight was less than 3000 grams. Out of the 42 successful ECV cases, 4 babies (9.52%) had neonatal sepsis and 1 was still born (2.3%) which was unrelated to ECV.Conclusions: ECV is a valuable though under used option in the management of breech presentation at term. It is a relatively safe procedure, simple to learn and perform. Vigilance for breech presentation after 36 weeks is important. ECV at term using tocolytics should be part of the routine management of breech presentation.

Experiences with High Success Rate of External Cephalic Version and Comparisons of Different Tocolysis for Risk-effective version based on a bayesian network meta-analysis

2020 ◽  
Author(s):  
Xiao Yunyun ◽  
Ma Si Yu ◽  
Li Jing ◽  
Zhao Wei ◽  
Dong Yan
Keyword(s):  
Amniotic Fluid ◽  
Bayesian Network ◽  
Success Rate ◽  
Meta Analysis ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
High Success Rate ◽  
Cochrane Library ◽  
Tocolytic Agents ◽  
Selection Of

Abstract Background: External cephalic version (ECV) has been proved effectively in reducing the cesarean section rates, but the success rates of the procedure are uneven. Experiences of ECV with high success rate were concluded in this paper. And in order to evaluate the efficiency of the applied tocolytic agents, a corresponding bayesian-network meta-analysis was conducted.Methods: Through retrospective analysis of eighty-four single pregnant women with breech presentation near or at term who received ECV from Dalian Maternal and Child Health Care Hospital from April 2017 to November 2019, influence factors associated with the success rate of ECV were analyzed. Meanwhile, a bayesian-network meta-analysis including sixteen eligible randomized controlled trials (RCTs) about comparisons of five common tololytic agents and placebo with 3468 participants searched from Pubmed, Cochrane library and Embase databases until May 20, 2019 was conducted to identify the efficiency of ritodrine and terbutaline applied in the authors’ procedures. Results: The ECV procedures were conducted by a skilled obstetrician through strict selection of the candidates. Oral ritodrine, intravenous terbutaline in combination with epidual analgesia were applied as interventions. Success rate of ECV reached 90.48% (76/84) and the overall vaginal delivery rate is up to 88.16% (67/76). Only one patient reverted to breech presentation due to loose of the bellyband. Among the possible variables, amniotic fluid index were identified to have significantly relationship with the success rate of ECV. As the bayesian network meta-analysis proved: terbutaline, salbutamol and ritodrine played more important roles than nitroglycerine and nifedipine on the success rate of ECV. But salbutamol was found to have more common side effects than terbutaline and ritodrine.Conclusions: We conclude that factors influencing the success rate of ECV mainly include: 1. characteristics of the mothers and fetuses, 2. interventions, 3. skills of the surgeon. During ECV process, selection of patients with enough amniotic fluid and proper stature with no contraindications is essential. And a more detailed scoring standard according to the possible influence indicators of the mothers and fetuses for the feasibility of ECV should be set up in the future. Besides, application of terbutaline and ritodrine as tocolytic agents during ECV procedure were considered to be effective for increasing successful versions.

scholarly journals A Survey on Causes of Cesarean Sections Performed on Women and Their Knowledge towards the Mode of Delivery

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Cesarean Delivery ◽  
Mode Of Delivery ◽  
Previous History ◽  
Breech Presentation ◽  
Cesarean Sections ◽  
College Hospital ◽  
Cross Sectional ◽  
Emergency Cesarean ◽  
Special Cases ◽  
History Of

Recently elective cesarean delivery rates have increased alongside with emergency cesarean delivery where less information has been conveyed to the women who have been subjected to C-sections. The main objective of C-section is reducing the incidence of maternal and neonatal mortality during childbirth in dangerous situations. It is recommended when there is a risk to mother or child during vaginal delivery. A descriptive type of cross-sectional study design was used. All the data were collected through structured format in questionnaires. The present study was carried out in the department of Obstetrics and Gynecology in the Chittagong Medical College Hospital. The data was collected from 29th September 2019 to 10th October 2019. Most of the patients who were subjected to c section were within the age range of 15-25 (57%). 41% of the cesarean sections were planned whereas 59% were on the basis of emergency and mostly the decision was doctor’s (66%). 58% of the population had enough information before undergoing C-sections and 42% wasn’t fully aware. Among pain medication intake, only 2% of the patients had taken a combination of three pain medications which include paracetamol, metronidazole and suppository. 80% of the patients consumed a combination of paracetamol and suppository whereas only 10% of population consumed paracetamol and metronidazole. 8% of the patients were managed only with paracetamol. 23% of the cesarean patients had a previous history of ceaser and among them some rare special cases had a previous history of 4 ceasers (2%). 43% of the patients suffered pregnancy induced hypertension and 8% suffered pregnancy induced diabetes. 20% of the c section were due to breech presentation and 80% were due to other reasons which included seventeen factors. Patients are not given enough information about C-section and mostly the decisions are taken by the doctors without the consent of the patients.

scholarly journals Predictors of Cephalic Vaginal Delivery Following External Cephalic Version: An Eight-Year Single-Centre Study of 447 Cases

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Natalie Kew ◽  
Jacobus DuPlessis ◽  
Domenic La Paglia ◽  
Katherine Williams
Keyword(s):  
Success Rate ◽  
Vaginal Delivery ◽  
Birth Outcome ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
International Standards ◽  
External Cephalic Version ◽  
Normal Vaginal Delivery ◽  
Success Rates ◽  
Hospital Data

Introduction. Our study aims to investigate and evaluate (1) rates of success of ECV for breech presentation at term at the Royal Women’s Hospital in comparison to international standards; (2) mode of delivery following ECV; (3) factors influencing success rates of ECV at the Royal Women’s Hospital. Methods. An audit of all women who underwent ECV between the years 2007 and 2014 at the Royal Women’s Hospital as public patients was completed. Data parameters were collected from paper and electronic patient files at the Women’s Hospital. Data was collected to analyse the effect of the following parameters on ECV success and birth outcome: age, parity, gestational age, BMI, AFI, and tocolytic use. These parameters were analysed to determine their effect on ECV outcome and birth outcome. Results. The Women’s Hospital, Melbourne, has an ECV success rate of approximately 37%. Of the patients undergoing ECV, 29% proceeded to normal vaginal delivery. Predictors of successful ECV included low BMI, multiparity, and AFI more than 16 (P<0.05). The only predictor of cephalic vaginal delivery following ECV was multiparity. Negative predictors of cephalic delivery were low AFI and nulliparity. Conclusions. The success rate of ECV at the Women’s Hospital, Melbourne, is in line with global standards.

scholarly journals Clinical analysis of 40 cases of external cephalic version without anesthesia

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098669
Author(s):  
Zheng Zhi ◽  
Lin Xi
Keyword(s):  
Breech Presentation ◽  
Clinical Analysis ◽  
Fetal Outcome ◽  
The Other ◽  
External Cephalic Version ◽  
Cesarean Sections ◽  
Related Factors ◽  
Safe Alternative ◽  
Multiparous Women ◽  
Successful Group

Objective This study aimed to investigate the success rate, complications, and success-related factors of external cephalic version (ECV) of singleton breech pregnancies after 37 gestational weeks without anesthesia. Methods We studied 40 singleton breech pregnancies in women who underwent ECV without anesthesia after 37 gestational weeks from October 2018 to March 2020. On the basis of success of ECV, the women were divided into two groups of the successful group and the failed group. Various factors were analyzed to determine those that affect the success of ECV. Results Of the 40 attempts of ECV, 24 (60.0%) were successful and 16 (40.0%) failed. With regard to success-related factors, parity was significantly different between the two groups, with more multiparous women in the successful group than in the failed group. However, none of the other factors were significantly different between the groups. Fetal outcome was good in all of the cases. Ultimately, 3 cesarean sections were performed in the successful group and 16 were performed in the failed group. Conclusions ECV of breech presentation after the 37th week of pregnancy without anesthesia is an effective and relatively safe alternative, and can effectively reduce the cesarean section rate.

External cephalic version in the outpatient clinic

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Gwang-Jun Kim ◽  
Ji Su Seong
Keyword(s):  
Cesarean Section ◽  
South Korea ◽  
Outpatient Clinic ◽  
Laboratory Tests ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Continuous Increase ◽  
Intravenous Access ◽  
Emergency Cesarean ◽  
Before And After

Abstract The continuous increase in the rates of cesarean section worldwide is concerning. Breech presentation is one of the major indications for cesarean section in most countries. External cephalic version (ECV) can reduce cesarean rates by approximately two-thirds in term breech pregnancies. After introduction of ultrasonography and cardiotocography before and after the procedure, ECV has become much safer. As a result, over-night fasting, intravenous access, and preoperative laboratory tests are no longer recommended as the patient’s risk of requiring emergency cesarean section is very low. We have been running the largest ECV clinic in South Korea since 2008, and ECV trials in the outpatient clinic were started in 2015. We want to share our experiences running the ECV clinic for 15 years managing more than 2000 patients.

A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term

2010 ◽  
Vol 112 (1) ◽  
pp. 48-51 ◽  
Author(s):  
Jorge Burgos ◽  
Juan Carlos Melchor ◽  
José Ignacio Pijoán ◽  
Patricia Cobos ◽  
Luis Fernández-Llebrez ◽  
...  
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Factors Associated ◽  
A Prospective Study

Maternal and perinatal outcomes in external cephalic version: prognostic factors for the success of the technique

2019 ◽  
Vol 47 (7) ◽  
pp. 717-723 ◽  
Author(s):  
Duna Trobo ◽  
Pilar Pintado ◽  
Virginia Ortega ◽  
Fátima Yllana ◽  
Concepción Hernández ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Prognostic Factors ◽  
Success Rate ◽  
Perinatal Outcomes ◽  
External Cephalic Version ◽  
Delivery Mode ◽  
Cesarean Sections ◽  
Third Trimester ◽  
Apgar Scores ◽  
The Third

Abstract Background We aimed to analyze the success rate of external cephalic version (ECV) for breech presentations performed in our center between March 2011 and March 2016. We evaluated factors related to a successful ECV, delivery mode, complications and newborn status after ECV. Methods Analysis of assembled data of 327 consecutive ECVs in the third trimester was done. Results The total success rate was 56.6%. After a successful ECV, 85.9% of the fetuses were delivered vaginally. Logistic regression analysis of background factors leading to a successful ECV showed that tocolysis with ritodrine and anterior placenta were each significantly correlated with the rate of successful version. No severe complications were registered during the ECVs, and all babies had normal Apgar scores at delivery. Conclusion These findings suggest that attempting an ECV in breech presentations, once or even twice, seems to be an appropriate management given that a successful ECV decreases the rate of cesarean section in this group of patients and by doing so, it might also decrease the risk of cesarean sections in future pregnancies.

scholarly journals External cephalic version at 38 weeks’ gestation at a specialized German single center

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0252702
Author(s):  
Ann-Sophie Zielbauer ◽  
Frank Louwen ◽  
Lukas Jennewein
Keyword(s):  
Success Rate ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Impact Factors ◽  
Amniotic Fluid Index ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
Predicting Factors ◽  
Tertiary Healthcare ◽  
Breech Birth

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.

scholarly journals Knowledge, attitude and practice of obstetricians towards external cephalic version

2021 ◽  
Author(s):  
Aisha Moon ◽  
Saima Shabbir
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Success Rate ◽  
Current Trend ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Cesarean Section Rate ◽  
Safe Procedure ◽  
Attitude And Practice ◽  
Knowledge Attitude And Practice

Background: Breech presentation is found in 3-5% of pregnant women at term. The cause for this fetal presentation may vary from fetal to maternal. Management option for breech presentation includes assisted vaginal breech birth, caesarean section and external cephalic version. External cephalic version is a maneuver performed to avoid breech presentation at term labor and helping the obstetricians to avoid complications of cesarean section. The success rate of ECV is 50%. Considering a high success rate and low risks it can be concluded that ECV can help reduce cesarean section rate of any region. The objective of this study is to determine the knowledge, attitude and practice of healthcare practitioners towards external cephalic version.Methods: This is an observational cross-sectional study conducted by the postgraduate trainee of Kulsumbai Valika social security SITE hospital, Karachi, Pakistan. By purposive sampling selection, there were 50 consultant obstetricians that have been well informed and were willing to complete KAP study questionnaires were enrolled to participate.Results: A total of 50 participants were included, 70% had clinical experience of more than 10 years. 80% considered ECV a safe procedure.75% believe that effective knowledge and practice of ECV can bring down cesarean section rate. If encountered by client with breech presentation 69% will manage with elective LSCS (lower segment caesarean section), 26% with ECV and only 5% will manage with assisted breech vaginal birth.Conclusions: For uncomplicated singleton breech at term, both ACOG and RCOG recommend external cephalic version. In Pakistan the current trend involves performing cesarean section for breech presentation. Effective knowledge, Proper training, and adequate practice can improve ECV uptake in our country. 

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