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.

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 CESAREAN SECTION

2010 ◽  
Vol 17 (02) ◽  
pp. 300-303
Author(s):  
BUSHRA SHER ZAMAN ◽  
Ali Zulqarnain ◽  
RASHAD QAMAR ◽  
Anza Saleem ◽  
SUMERA SIDDIQUE
Keyword(s):  
Cesarean Section ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Apgar Score ◽  
Distress Syndrome ◽  
Breech Presentation ◽  
Neonatal Morbidity ◽  
Birth Trauma ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

Objective: It is to compare neonatal morbidity in terms of birth trauma, respiratory distress syndrome, APGAR score in Primigravida with breech presentation delivered vaginally and emergency cesarean section. Design: Cross-sectional comparative study. Place and Duration of Study: Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur from 1-5-2007 to 30-4-2008. Patients and Method: The study was carried out on all Primigravida with breech presentation reported through emergency in labour deliveredvaginally and by emergency cesarean section. The variable analyzed were birth trauma, respiratory distress syndrome and APGAR score at 1 and 5 minutes. Students-t test was used for comparison between means and chi square test for comparison between percentages. Significance was taken at P<0.05. Results: It was found that mean APGAR score at 1 and 5 minutes is 7.31 and 9.066 in vaginal and 8.533 and 9.644 incesarean group. Respiratory distress syndrome is more in cesarean (4.4%) than vaginal group (2.2%). Observed neonatal trauma is more in vaginal group (6.7%) than cesarean section (2.2%). Conclusion: Neonatal morbidity appears to be more in vaginal breech delivery than cesarean section for Primigravida with breech presentation at term. 

scholarly journals REVIVAL OF VAGINAL BREECH DELIVERY

1969 ◽  
Vol 5 (1) ◽  
pp. 597-602
Author(s):  
NASIM AKHTAR
Keyword(s):  
Cesarean Section ◽  
Neonatal Mortality ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Neonatal Morbidity ◽  
Maternal Complications ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
Emergency Cesarean

BACKGROUND: Since the publication of term breech trail there had been a dramatic changeworldwide from selective to planned Cesarean Section for all women with breech presentation at term.This high cesarean section rate led to adverse consequences in subsequent pregnancy &on futurefertility. Choice of safest mode of delivery has always been a dilemma.OBJECTIVE: Prospective interventional study. This study was done to determine the safety of vaginalbreech birth in terms of neonatal & maternal complications, so that to encourage the trend of breechdelivery in carefully selected cases & to discourage the trend of routinely recommending cesareansection for all gravidas with fetus in breech presentation at term. The study was conducted atDepartment of Obstetrics & Gynae Mardan Medical Complex from January 2010 to December 2015.PATIENTS & METHOD: About 809 patients with singleton pregnancy with breech presentation wereincluded. Decision about mode of delivery was taken on the basis of clinical judgment and ultrasoundwhich was further reviewed in the light of rate of progress during labour .Delivery was conducted byexperienced obstetrician. Mother & infants were followed up to 6 wks post partum. The primaryoutcome was neonatal mortality, infant mortality & serious infant morbidity.RESULTS: out of 809 total patients with breech presentation, 714 were planned for vaginal delivery674 delivered (83%) while 40 pts (5%) had emergency Cesarean Sections.95 patients (12%) hadElective cesarean section. In the delivery group two (0.29%) neonates had serious neonatal morbidity. Inthe cesarean group there was no serious neonatal morbidity. Infection & blood loss was greater in thecesarean group. There were no serious maternal complications in the vaginal delivery group. Thedifference between neonatal morbidity, perinatal mortality &neonatal mortality between the two groupswas not significant.CONCLUSION: Vaginal breech delivery is still a safe option which better suits the clinical situation&problems of our patients .In our set up, Cesarean section should not be routinely advised to patientswith breech presentation no matter it may be the best management option in developed countries.Careful case selection & vigilant monitoring of progress of labour will save many patients fromunnecessary section without costing extra morbidity & mortality.KEY WORDS: Breech presentation, Breech Delivery, Cesarean section, Apgar score.

scholarly journals Use of a Classification Tool to Determine Groups of Women That Contribute to the Cesarean Section Rate: Establishing a Baseline for Clinical Decision Making and Quality Improvement

2012 ◽  
Vol 2 (2) ◽  
pp. 85-95 ◽  
Author(s):  
Valerie Slavin ◽  
Jennifer Fenwick
Keyword(s):  
Cesarean Section ◽  
Classification System ◽  
Clinical Decision Making ◽  
Breech Presentation ◽  
Clinical Decision ◽  
Models Of Care ◽  
Group Classification ◽  
External Cephalic Version ◽  
Cesarean Section Rate ◽  
Classification Tool

OBJECTIVE:To identify the groups of women who are the largest contributors to the cesarean section rate at a maternity facility in South East Queensland, Australia. Examining the characteristics of these women will allow the development of unit-focused initiatives aimed at reducing cesarean sections in these groups of women.METHOD:A modified version of the Robson Ten Group Classification System was identified as the most appropriate tool to determine cesarean section rates in different groups of women. A prospective clinical audit was then carried out during a 6-month period in 2010 using the tool.FINDINGS:The Robson Ten Group Classification System identified that planned repeat cesarean section was the largest contributor to the cesarean rate. This was followed by women having their first baby, women having an induction, and women who have a breech presentation at term.CONCLUSIONS AND IMPLICATIONS:The Robson classification tool was useful in identifying groups of women at risk of a cesarean section. Unit-specific strategies can now be developed and implemented in an effort to lower the rate. These include increasing the vaginal birth after cesarean rate, the uptake of external cephalic version, supporting nonintervention birth environments, and implementing models of care where clinicians are skilled in facilitating normal birth. The value of using such a tool is the ability to monitor change over time as well as facilitating the comparison of data between units of a similar nature.

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