scholarly journals Central Neuraxial Blockade-Assisted External Cephalic Version in Reducing Caesarean Section Rate: Systematic Review and Meta-Analysis

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Ibrahim Bolaji ◽  
Lillian Alabi-Isama
Keyword(s):  
Caesarean Section ◽  
Motor Nerve ◽  
Meta Analysis ◽  
Caesarean Section Rate ◽  
Economic Value ◽  
Cost Savings ◽  
External Cephalic Version ◽  
Group Code ◽  
Neuraxial Blockade ◽  
Randomized Controlled Studies

We review the medical literature on the success, safety and economic value of central neuraxial blockade-assisted (CNB) external cephalic version from randomized controlled studies identified from 1951 to 2009. The result showed that more women had successful ECV with regional anaesthesia with corresponding reduction in caesarean section rate. They were 1.5 times more likely than women not receiving anaesthesia to have a successful ECV. The number to treat is six women needed to receive anaesthesia for 1 baby to be turned from breech to cephalic presentation. Feto-maternal morbidity was not increased in the CNB-aided group consisting of only transient bradycardia. Although the appropriate amount of force for safe version has not been quantified, there was no report of uterine rupture despite removal of these patients from “excessive force-pain biofeedback loop” induced through motor nerve blockade. We can attribute 30% of cost savings amounting to £42,150.00 directly to CNB using the most up to date Health Resource Group Code (HRG4). The initial results are encouraging but until the benefits and safety of CNB-aided ECV are substantiated by large randomized, blinded controlled trials, this practice cannot be universally recommended.

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.

scholarly journals Successful External Cephalic Version: Factors Predicting Vaginal Birth

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Pei Shan Lim ◽  
Beng Kwang Ng ◽  
Anizah Ali ◽  
Mohamad Nasir Shafiee ◽  
Nirmala Chandralega Kampan ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Caesarean Section Rate ◽  
Vaginal Birth ◽  
External Cephalic Version ◽  
Control Group ◽  
Study Group ◽  
Amniotic Fluid Index ◽  
Additional Information ◽  
The Mean

Purpose. To determine the maternal and fetal outcomes of successful external cephalic version (ECV) as well as factors predicting vaginal birth.Methods. The ECV data over a period of three years at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 1 September 2008 and 30 September 2010 was reviewed. Sixty-seven patients who had successful ECV were studied and reviewed for maternal, fetal, and labour outcomes. The control group comprised patients with cephalic singletons of matching parity who delivered following the index cases.Results. The mean gestational age at ECV was263±6.52 days (37.5 weeks ± 6.52 days). Spontaneous labour and transient cardiotocographic (CTG) changes were the commonest early adverse effects following ECV. The reversion rate was 7.46%. The mean gestational age at delivery of the two groups was significantly different (P=0.000) with277.9±8.91days and269.9±9.68days in the study group and control groups, respectively. The study group needed significantly more inductions of labour. They required more operative deliveries, had more blood loss at delivery, a higher incidence of meconium-stained liquor, and more cord around the neck. Previous flexed breeches had a threefold increase in caesarean section rate compared to previous extended breeches (44.1% versus 15.2%,P=0.010). On the contrary, an amniotic fluid index (AFI) of 13 or more is significantly associated with a higher rate of vaginal birth (86.8% versus 48.3%,P=0.001).Conclusions. Patients with successful ECV were at higher risk of carrying the pregnancy beyond 40 weeks and needing induction of labour, with a higher rate of caesarean section and higher rates of obstetrics complications. Extended breech and AFI 13 or more were significantly more likely to deliver vaginally postsuccessful ECV. This additional information may be useful to caution a patient with breech that ECV does not bring them to behave exactly like a normal cephalic, so that they have more realistic expectations. However, these predictive factors needed further confirmation and hopefully, in the future, they would be able to further enhance counselling prior to ECV.

scholarly journals Caesarean Section Audit: The Use of the Robson’s Criteria in a Teaching Hospital with Limited Advanced Fetal Surveillance

2020 ◽  
Vol 5 (07) ◽  
pp. 217-221
Author(s):  
Babatunde Ajayi Olofinbiyi ◽  
Jacob Olumuyiwa Awoleke ◽  
Oluwole Dominic Olaogun ◽  
Adeyemi Sunday Adefisan ◽  
Oluwafunke Rebecca Olofinbiyi ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Teaching Hospital ◽  
Caesarean Section Rate ◽  
Group Classification ◽  
University Teaching ◽  
Active Management ◽  
External Cephalic Version ◽  
Health Concern ◽  
Continuous Training ◽  
Fetal Surveillance

Background: Rising caesarean section rates have become a global health concern. The need for a contemporary objective tool for comparison of rates, optimizing and standardizing the use of caesarean section has been met by the Robson’s Ten-Group classification. However, there are no available studies auditing caesarean section rates in southern Nigeria using these criteria. Methods: All mothers delivered by caesarean section over a 12-month period at Ekiti State University Teaching Hospital, Ado – Ekiti, were prospectively captured and classified according to Robson’s 10-group classification with a view to detecting which clinically relevant groups contributed most to the caesarean section rate. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) 20. Results: The total deliveries recorded over the study period was 2,139, out of which 760 underwent caesarean section, thus giving a Caesarean Section Rate of 35.5%. Group 1 had the highest contribution to Caesarean section rate, followed by Group 5. There was a statistically significant relationship between booking status of the patients and the various groups in the Robson’s classes (p < 0.001). Conclusion: There should be continuous training and drills on active management of labour, supportive companionship in labour, and improved fetal surveillance techniques to reduce the rates of primary caesarean section. Developing locally-adapted eligibility criteria to increase successful trials of labour after caesarean section, revisiting external cephalic version, and addressing potentially modifiable risks for preterm birth are advocated.

scholarly journals Analysis of incidence of caesarean sections in primigravida

2021 ◽  
Vol 10 (4) ◽  
pp. 1433
Author(s):  
Suyujna D. Joshi ◽  
Rajeshwari Rai ◽  
Ruksar Banu ◽  
Jayasakthi G.
Keyword(s):  
Caesarean Section ◽  
Middle Class ◽  
Rural Areas ◽  
Urban Areas ◽  
District Hospital ◽  
Meta Analysis ◽  
Caesarean Section Rate ◽  
Lower Class ◽  
Background Current ◽  
Male Fetus

Background: Current study was conducted to determine the incidence of caesarean sections in primigravida.Methods: A total number of 1698 primigravidas were admitted in the department of DNB district hospital Ballari, out of which 501 primigravidas who underwent caesarean section were included in the study.Results: Caesarean section rate in primigravida was observed to be 29.5%, 55% of women were from rural areas and 45% from urban areas, 69.9% women belonged to lower class 31.1% belonged to upper middle class, 25% were illiterate while 75% were literate.Conclusions: Meta-analysis suggests that the occurrence of pregnancy complications differ according to fetal sex with a higher cardiovascular and metabolic load for the mother in the presence of a male fetus. 

scholarly journals Audit of caesarian deliveries in a tertiary care center, in rural Bangalore, India

2019 ◽  
Vol 8 (4) ◽  
pp. 1408
Author(s):  
Rajiv K. Saxena ◽  
Anju Balan
Keyword(s):  
Caesarean Section ◽  
Teaching Hospital ◽  
Care Center ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
External Cephalic Version ◽  
Tertiary Care Center ◽  
Tertiary Care Teaching Hospital ◽  
Breech Delivery ◽  
Care Teaching

Background: The Robson’s Ten-Group Classification System allows critical analysis of caesarean deliveries according to characteristics of pregnancy. The objective was to analyze caesarean section rates in a rural tertiary care teaching hospital in Bangalore, using Robson’s ten groups classification.Methods: This study was done in MVJ Medical College and Research Hospital, a rural tertiary care teaching hospital. All patients who underwent caesarean delivery, between November 2017 and October 2018, were included in the study. Women were classified in 10 groups according to Robson’s classification. For each group, authors calculated its relative contribution to the overall caesarean rate.Results: The overall caesarean section rate was 46.7%. The main contributors to this high caesarean rate were primiparous women in spontaneous labour (group 1) and women with previous caesarean section (group 5).  52.1% of CS were conducted on women who were unbooked or booked at a peripheral health facility and referred to present institution due to complications in labor. Strategies to lower CS rates would include encouraging women with previous CS, to undergo trial of labor to reduce CS rates for group 5C. Sensitization of staff in peripheral medical facilities for early referral of high-risk pregnancies to a tertiary care center for better control of medical complications like hypertensive disorders of diabetes mellitus. Other strategies include offering external cephalic version to eligible women with breech presentation and consider offering vaginal breech delivery to suitable women in groups 6 and 7.Conclusions: The Robson’s classification is easy to use. It is time to implement obstetric audit to lower the overall CS rates.

Relationship between total plasma homocysteine and the risk of aneurysms – a meta-analysis

VASA ◽  
2020 ◽  
pp. 1-6
Author(s):  
Hanji Zhang ◽  
Dexin Yin ◽  
Yue Zhao ◽  
Yezhou Li ◽  
Dejiang Yao ◽  
...  
Keyword(s):  
Large Scale ◽  
Meta Analysis ◽  
Single Species ◽  
Total Plasma ◽  
Control Groups ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
The Difference ◽  
The Relationship ◽  
Healthy Participants

Summary: Our meta-analysis focused on the relationship between homocysteine (Hcy) level and the incidence of aneurysms and looked at the relationship between smoking, hypertension and aneurysms. A systematic literature search of Pubmed, Web of Science, and Embase databases (up to March 31, 2020) resulted in the identification of 19 studies, including 2,629 aneurysm patients and 6,497 healthy participants. Combined analysis of the included studies showed that number of smoking, hypertension and hyperhomocysteinemia (HHcy) in aneurysm patients was higher than that in the control groups, and the total plasma Hcy level in aneurysm patients was also higher. These findings suggest that smoking, hypertension and HHcy may be risk factors for the development and progression of aneurysms. Although the heterogeneity of meta-analysis was significant, it was found that the heterogeneity might come from the difference between race and disease species through subgroup analysis. Large-scale randomized controlled studies of single species and single disease species are needed in the future to supplement the accuracy of the results.

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