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.

Prematurity, multiple gestation, and abnormal presentation

2016 ◽  
Author(s):  
Oonagh Keag ◽  
E. Sarah Cooper
Keyword(s):  
Preterm Labour ◽  
Multiple Pregnancy ◽  
Breech Presentation ◽  
Neonatal Morbidity ◽  
External Cephalic Version ◽  
Multiple Gestation ◽  
Antenatal Corticosteroids ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
Maternal Risks

Preterm labour is a common cause of neonatal morbidity and mortality. This chapter describes the definition, aetiology, diagnosis, and management of preterm labour and delivery with a focus on tocolytic therapy, the use of antenatal corticosteroids, and of magnesium sulphate. Anaesthesia for preterm delivery is discussed. The section on multiple pregnancy details the recommended antenatal careplan for dichorionic and monochorionic twin pregnancies, the fetal and maternal risks and potential complications, and the management of labour and delivery of twins, as well as the anaesthetist’s role in managing these high-risk pregnancies. There are a number of abnormal presentations managed by obstetricians, including abnormal cephalic presentations such as occiputo-posterior positions, breech, transverse, and compound presentations. This chapter focuses specifically on breech presentation, comparing the evidence for vaginal breech delivery versus planned caesarean delivery. It also discusses external cephalic version and vaginal breech delivery itself.

External Cephalic Version at Term with Tocolysis

1988 ◽  
Vol 18 (3) ◽  
pp. 119-124 ◽  
Author(s):  
G Justus Hofmeyr
Keyword(s):  
Developing Countries ◽  
Caesarean Section ◽  
Breech Presentation ◽  
External Cephalic Version ◽  
Cephalopelvic Disproportion ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
High Prevalence ◽  
Large Families ◽  
Tocolytic Agents

The problems associated with breech presentation are of particular importance in developing countries. The risk of vaginal breech delivery may be increased because of a high prevalence of cephalopelvic disproportion. Caesarean section presents specific risks to women who may not have medical care in subsequent pregnancies and may desire large families. External cephalic version (ECV) before term has not been proved conclusively to influence the outcome of pregnancy. ECV performed at term (37 or more weeks gestation), using tocolytic agents to relax the uterus, has been shown in a technologically developed setting to reduce the incidence of breech presentation and of Caesarean section. The application of this procedure when technological facilities are limited is discussed and the technique is described.

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.

Variations in the Management of Singleton Breech Presentation Throughout Scotland

1998 ◽  
Vol 43 (5) ◽  
pp. 144-145 ◽  
Author(s):  
S. Z. S. Yahya ◽  
J. Williams ◽  
A. Mathers ◽  
S. Bjornsson ◽  
A. D. Cameron ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Breech Presentation ◽  
Postal Questionnaire ◽  
External Cephalic Version ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
Post Procedure ◽  
Line Management

Breech presentation occurs in 3–5% of deliveries and can be managed by either a trial of vaginal breech delivery (TOVBD), external cephalic version (ECV) or Caesarean section.1 A postal questionnaire was completed by 82% of Scottish consultant obstetricians and revealed wide variations in practice. Eighteen percent never offered ECV. Among those who did consensus was lacking on some contraindications. One-quarter sometimes performed ECV before 37 weeks gestation despite the possibility ofspontaneous version. Only 70% restricted ECV to one or more designated operators thereby maintaining levels of expertise. Variations were demonstrated in the use of tocolytics, and pre and post procedure investigations. Following failed ECV 28% considered a repeat attempt and 56% a TOVBD. TOVBD was not offered asjirst line management by one-fifth of respondents. Those who did varied in the pre-procedure investigations performed. Guidelines are required to ensure safe, consistent practice and avoid unnecessary Caesarean sections.

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 The Effects of Clinical Hypnosis versus Neurolinguistic Programming (NLP) before External Cephalic Version (ECV): A Prospective Off-Centre Randomised, Double-Blind, Controlled Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Joscha Reinhard ◽  
Swati Peiffer ◽  
Nicole Sänger ◽  
Eva Herrmann ◽  
Juping Yuan ◽  
...  
Keyword(s):  
Medical Care ◽  
Success Rate ◽  
Controlled Trial ◽  
Randomised Trial ◽  
External Cephalic Version ◽  
Control Group ◽  
Amniotic Fluid Index ◽  
Double Blind ◽  
Standard Medical Care ◽  
Clinical Hypnosis

Objective. To examine the effects of clinical hypnosis versus NLP intervention on the success rate of ECV procedures in comparison to a control group.Methods. A prospective off-centre randomised trial of a clinical hypnosis intervention against NLP of women with a singleton breech fetus at or after 370/7(259 days) weeks of gestation and normal amniotic fluid index. All 80 participants heard a 20-minute recorded intervention via head phones. Main outcome assessed was success rate of ECV. The intervention groups were compared with a control group with standard medical care alone ().Results. A total of 42 women, who received a hypnosis intervention prior to ECV, had a 40.5% (), successful ECV, whereas 38 women, who received NLP, had a 44.7% () successful ECV (). The control group had similar patient characteristics compared to the intervention groups (). In the control group () 27.3% () had a statistically significant lower successful ECV procedure than NLP () and hypnosis and NLP ().Conclusions. These findings suggest that prior clinical hypnosis and NLP have similar success rates of ECV procedures and are both superior to standard medical care alone.

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 Outcome of breech delivery: caesarean section versus vaginal delivery at Patan Hospital, Patan Academy of Health Sciences

2016 ◽  
Vol 3 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Anagha Pradhan Malla ◽  
Laxmi RC ◽  
Alka Singh ◽  
Reena Shrestha ◽  
Padma Gurung ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Maternal Blood ◽  
Health Sciences ◽  
Term Infant ◽  
Critical Element ◽  
Intrauterine Death ◽  
Breech Delivery ◽  
Vaginal Breech Delivery

Introductions: Obstetricians have long debated the role of caesarean section as a potentially safer mode of delivery for the fetus with breech presentation. However, the experience of the health care provider remains a critical element in the decision to pursue a vaginal breech delivery, and it may still be a viable option. The aim of this study is to determine the incidence of breech delivery at Patan Hospital and compare maternal and neonatal outcomes subjected to either vaginal or caesarean section.Methods: This was a five-year retrospective study of breech deliveries covering the year 2010 to 2014. Patient’s charts were retrieved from the medical record section and reviewed.Results: There were 896 breech deliveries out of a total 44,842 deliveries giving an incidence of 1.99%. One hundred thirteen (12.61%) of breech deliveries were through vaginal route while 431 (48.10%) and 352 (39.28%) were through emergency and elective caesarean sections respectively. There were 154 (17.18%) preterm breech deliveries including 27 (17.5%) preterm intrauterine death. Among term pregnancy, there were 3 neonatal deaths not associated with mode of delivery. None of the term infant had neurological morbidity comprising neonatal seizures, brachial plexus injury, chephalohematoma. Maternal blood loss was significantly higher in caesarean section group. Conclusions: In well-selected cases, the neonatal outcome following assisted vaginal breech delivery and caesarean section may not be different.Journal of Patan Academy of Health Sciences, Vol. 3, No. 1, 2016. page: 4-9

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