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 Breech presentation at term: outcomes and mode of delivery in a tertiary care teaching hospital In South India

2019 ◽  
Vol 8 (10) ◽  
pp. 4111
Author(s):  
Liji David ◽  
Anuja Abraham ◽  
Preethi Navaneethan ◽  
Annie Regi
Keyword(s):  
Retrospective Study ◽  
Vaginal Delivery ◽  
Teaching Hospital ◽  
Maternal Morbidity ◽  
South India ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Clinical Records

The aim of this study was to study the outcomes of all patients who presented with breech presentation at term (≥37 weeks), to assess what percentage of patients were offered External cephalic version (ECV), the rates of success of the procedure and the rates of vaginal delivery following successful ECV. It was a retrospective study of 669 patients diagnosed with breech at term, their clinical records were retrieved and data like age, BMI, parity, type of breech and scan findings noted. ECV was done in 256 patients and was successful in 35.5% of women with 51.1% being multigravidas and 26.8% in primigravidas. 76.9% of women with successful ECV delivered vaginally.  There was no significant fetal or maternal morbidity documented as a result of ECV in this study.  

scholarly journals A Clinical Study of Labour and Outcome in Hundred Cases of Primigravida in Dhaka Medical College and Hospital

2018 ◽  
Vol 27 (1) ◽  
pp. 9-13
Author(s):  
Kaniz Fatema ◽  
Tabassum Ghani ◽  
Subinoy Krishna Paul ◽  
Noorjahan ◽  
Afrina Begum ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Study Data ◽  
Normal Vaginal Delivery ◽  
Age Group ◽  
Medical College ◽  
Number Of Patients ◽  
Predominant Factor ◽  
First Time

Introduction: Primigravida is one, who is pregnant for the first time. A successful well managed vaginal delivery first time around usually leads to subsequent deliveries being relatively uneventful. Conversely, a poorly managed first labour can add to subsequent obstetric problems. Therefore, utmost care and expertise is a predominant factor for a successful delivery. Aims and objectives: Objectives of this study is to enhance the rate of safer delivery for primigravida through monitoring progress of labour, mode of delivery and fetomaternal outcome. Methodology: This prospective study was carried out at labour ward in the Department of obstetrics and Gynaecology of Dhaka Medical College & Hospital from January, 2007 to June 2007. Hundred cases of primigravida were selected for this study. Data had been collected through questionnaires. Results : Largest number of patients (50%) had age group 20-24 years and likely to have normal vaginal delivery. Sixty percent patients had regular antenatal check up. Risk factors like PIH, Breech presentation, Face presentation, Rh negative, Jaundice and Pyrexia were found in 23% cases.About 96% fetuses presented by vertex, among them 52% had non engaged head. Sixty patients came with cervix at or less 3 cm dilated and 40 patients were at cervical dilatation 4 cm or more. Progress of labour was monitored by modified WHO partograph. Sixty two percent patient delivered vaginally, among them 3% patients need instrumental delivery. Thirty eight patients pregnancy were terminated by caesarean section. Ninety nine percent babies were live birth and 1% was still birth. Conclusion :Safest age group for delivery of primigravida in this study between 20-24 years. So, women should be encouraged to have their 1st child at this age. People should be made aware of the benefits of proper antenatal check up and choosing safest place for delivery. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 9-13

Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation

2017 ◽  
Vol 127 (4) ◽  
pp. 625-632 ◽  
Author(s):  
Laurie A. Chalifoux ◽  
Jeanette R. Bauchat ◽  
Nicole Higgins ◽  
Paloma Toledo ◽  
Feyce M. Peralta ◽  
...  
Keyword(s):  
Success Rate ◽  
Cesarean Delivery ◽  
Meta Analysis ◽  
Randomized Study ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Double Blind ◽  
Additional Increase ◽  
Dose Response Effect

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.

scholarly journals Pregnancy outcome of external cephalic version in singleton pregnancy with breech presentation at term

2020 ◽  
Vol 9 (6) ◽  
pp. 2352
Author(s):  
Rajesh Kumar Mishra ◽  
Shakti Vardhan ◽  
Sanjay Singh ◽  
Swati Sagarika Panda
Keyword(s):  
Success Rate ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Care Hospital ◽  
Singleton Pregnancy ◽  
Breech Delivery ◽  
Singleton Pregnancies

Background: Breech delivery is associated with poor perinatal outcomes irrespective of the route of delivery. External cephalic version can be a useful tool in management of breech presentation at term by converting it to a cephalic presentation. A study was conducted to evaluate maternal and neonatal outcome of external cephalic version in singleton pregnancies with breech presentation in third trimester.Methods: A prospective observational study was carried out at a tertiary care hospital over a period of 2 years. This study included a total of 65 uncomplicated cases of breech presentation who fulfilled the inclusion criteria. External cephalic version was carried out after 36 weeks of period of gestation in primigravida and after 37 weeks in multigravida women. These patients were followed up till delivery and data was collected and analysed regarding the mode of delivery, maternal and fetal outcome.Results: External cephalic version was successful in 41 patients with a success rate of 63%. Out of them, vaginal delivery could be achieved in 31 cases (75.6%) and LSCS was done for rest of the 10 cases. The success rate was higher in multigravida ladies compared to primigravida ladies. No major procedure related adverse event was noticed in our study.Conclusions: External cephalic version is a very safe and easy procedure which can reduce the rate of cesarean delivery in singleton pregnancies with breech presentation. The results of this study are in favor of wider practice of this procedure in selected cases.

Fetal Malpresentation in Pregnancy

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

scholarly journals On demand caesarean section: What’s women’s attitude?

1970 ◽  
Vol 2 (2) ◽  
pp. 12-15
Author(s):  
Nira S Shrestha ◽  
Sumita Pradhan
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Mode Of Delivery ◽  
University Teaching ◽  
Normal Vaginal Delivery ◽  
On Demand ◽  
Assisted Delivery ◽  
The Right

Objectives: To evaluate the knowledge and attitude of Nepalese women towards mode of delivery and caesarean on demand. Study design: Hospital based cross sectional descriptive study where 200 pregnant women after 37 completed weeks of gestation were recruited randomly and interviewed, and their answers were analyzed. Results: Of the 200 interviewed pregnant women, all of them knew about normal vaginal delivery and caesarean delivery, but only 30% knew about instrumentally assisted delivery and 9% had heard about painless labour. Vaginal delivery was the preferred mode in 93% and 7% preferred caesarean delivery. Only 35% of the interviewed women believed that women should have the right to demand a caesarean section Conclusion: Knowledge assessment of two hundred women regarding the mode of delivery clearly indicates the need for strengthening counseling aspect of antenatal care and awareness program regarding mode of delivery. In Nepal on demand caesarean section is not provided in the University Teaching Hospital. However one third of women still felt that women should have the right to choose caesarean section on demand. Key words: Attitude, mode of delivery, Caesarean on demand. doi:10.3126/njog.v2i2.1448 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 12 - 15

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

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.

scholarly journals Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

2019 ◽  
Vol 31 (1) ◽  
pp. 23-26
Author(s):  
Mahe Jabeen ◽  
Sabiha Shimul ◽  
Ummay Salma ◽  
Jebunnesa
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Maternal Morbidity ◽  
Neonatal Outcome ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Cost Of Care ◽  
Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

scholarly journals PAINLESS DELIVERY

2016 ◽  
Vol 23 (04) ◽  
pp. 467-471
Author(s):  
Laleh Dehghanpisheh ◽  
Golnar Sabetian ◽  
Zeinabosadat Fatahi
Keyword(s):  
Vaginal Delivery ◽  
International Standards ◽  
Normal Vaginal Delivery ◽  
Natural Childbirth ◽  
Mother And Child ◽  
Spss Software ◽  
Painless Labor ◽  
Labor Method ◽  
Study Setting ◽  
Average Information

One of the most severe pain that a woman experiences in her lifetime is laborpain which leads to increase their desire to perform caesarean section. In the present study weassessed the attitudes and awareness of obstetricians and midwives by raising their knowledgeand skills, to increase the rate of vaginal delivery and reduce the cesarean. Methods: StudyDesign: Qualitative study. Setting: Obstetricians and Midwives from throughout the ShirazCity, South of Iran, were participated by completing the questionnaire. Period: 6 months in2015. Statistical analysis was performed using the SPSS software, version 20.0. The resultswere presented as frequency (percentage). Results: 118 individuals including 25 (21%)Obstetricians and 93 (79%) Midwives were participated in the current study. Both obstetriciansand midwives preferred normal vaginal delivery (NVD) (83.9%). 91% of subjects believed thatthe reason of preference of NVD is the safety of mother and child. 34.7% of individuals wasfully aware of painless labor. 21.2% had average information. Most of the subjects was agreedwith the painless labor method (92.4%) and 4.2% was disagreed. Lack of pain and calmnessduring labor (62.2%) and reduction of fear of natural childbirth (50.5%) were the main reasonsof agreements. 85.2% of obstetrics and midwives believed that the number of painless labor inIran in comparison to international standards is less than desired. Conclusions: Although themajority of obstetricians and midwives were agreed with the painless labor in hospitals, almosthalf of them were aware of the painless delivery. Raising the knowledge of health care providersabout painless delivery can influence on awareness and attitude of them and parturient towardnormal vaginal delivery.

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.

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