Effect Of External Cephalic Version Research Articles

EXAMINING PREGNANCY OUTCOMES AFTER EXTERNAL CEPHALIC VERSION FOR BREECH PRESENTATION

External cephalic version (ECV) is a non-invasive procedure performed to reposition a breech fetus into the cephalic position before labor, thus reducing the risk of cesarean delivery. This study aims to examine pregnancy outcomes following external cephalic version for breech presentation. A retrospective analysis of maternal and neonatal outcomes was conducted among women who underwent ECV for breech presentation at a tertiary care center over a specified period. Data on the success rate of ECV, mode of delivery, neonatal outcomes, and maternal complications were collected and analyzed. The findings provide insights into the safety and effectiveness of ECV in improving pregnancy outcomes for women with breech-presenting fetuses.

The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study

External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. Following ECV, fetal well-being is assessed via a non-stress test (NST). An alternative option to identify signs of fetal compromise is via the Doppler indices of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). Inclusion criteria were an uncomplicated pregnancy with breech presentation at term. Doppler velocimetry of the UA, MCA and DV were performed up to 1 h before and up to 2 h after ECV. The study included 56 patients who underwent elective ECV with a success rate of 75%. After ECV, the UA S/D ratio, UA pulsatility index (PI) and UA resistance index (RI) were increased compared to before the ECV (p = 0.021, p = 0.042, and p = 0.022, respectively). There were no differences in the Doppler MCA and DV before or after ECV. All patients were discharged after the procedure. ECV is associated with changes in the UA Doppler indices that might reflect interference in placental perfusion. These changes are probably short-term and have no detrimental effects on the outcomes of uncomplicated pregnancies. ECV is safe; yet it is a stimulus or stress that can affect placental circulation. Therefore, careful case selection for ECV is important.

Factors influencing the effect of external cephalic version: a retrospective nationwide cohort analysis.

This study aims to assess the factors associated with the success and failure rate of the external cephalic version (ECV) in breech fetuses. Secondary outcomes were fetal presentation in labor and mode of delivery. This cross-sectional study examined the live birth certificates from 2003 through 2020 from US states and territories that implemented the 2003 revision. A total of 149,671 singleton pregnancies with information about ECV success or failure were included. The outcome was ECV success/failure, while the exposures were possible factors associated with the outcome. The successful ECV procedures were 96,137 (64.23%). Among the successful ECV procedures, the prevalence of spontaneous vaginal delivery was 71.63%. Among the failed ECV procedures, 24.74% had a cephalic presentation at delivery, but 63.11% of these pregnancies were delivered by cesarean section. Nulliparity, female sex, low fetal weight centile, high pre-pregnancy BMI, high BMI at delivery, and high maternal weight gain during pregnancy were associated with an increased ECV failure (p < 0.001). African American, American Indian and Alaska Native race categories were significant protective factors against ECV failure (p < 0.001). Maternal age had a U-shape risk profile, whereas younger maternal age (< 25years) and old maternal age (> 40years) were significant protective factors against ECV failure (p < 0.001). A high prevalence of successful ECV procedures and subsequent spontaneous vaginal delivery were found. The present results found nulliparity, maternal race, maternal age, female fetal sex, low fetal weight, and maternal anthropometric features correlated to ECV results. These findings can potentially improve the knowledge about the factors involved in ECV, allowing more informed counseling to the women undergoing this procedure.

715 Cost-Effectiveness of external cephalic version for term breech presentation: a single center experience

Breech presentation occurs in 3–4% of term pregnancies and is an indication for almost one-fifth of primary cesarean deliveries. External cephalic version(ECV) has been considered as an alternative to cesarean delivery for those who wish to undergo a trial of labor and have no contraindication to vaginal delivery. The objective of this study is to determine the effect of external cephalic version on the cesarean section rate and to calculate the cost savings associated with successful version It is a retrospective study of all women with a singleton pregnancy and non-cephalic presentation who had an attempted ECV at or after 36 weeks of gestation at a single tertiary center. After approval by our institutional IRB, Patients’ charts were reviewed from January 2012 to December 2017 Overall 372 women underwent ECV during the study period, of whom 324 were eligible for analysis. ECV was successful in 237(73.1 %) of the 324 attempted versions and unsuccessful in 87 (26.9%). Eighty-one percent of patients (n=193)who had successful versions were delivered vaginally and 19 % (n=44) by cesarean section. Of the 87 women with unsuccessful version, seven patients (7.8%) were noted to have cephalic presentation when they presented in labor and were delivered vaginally.The cesarean section rate was significantly lower in the patients who had successful ECV (n=44, 18.6%) compared to those who had failed ECV (n=80, 92%, P- < 0.001)(Fig 1 ). The resulting total number of vaginal deliveries (n = 200) allowed for a 34.6% savings in the total cost of these deliveries, and 96.5% of these savings were attributed to successful ECV. Overall, the average cost and cost savings of the study population were $4,366,096 and $2,228,764 respectively(Fig 2). No major fetal or maternal complications were observed. ECV significantly reduces the cesarean section rate and the cost associated with delivery in patients with breech presentation at term. It should be considered a safe alternative to the cesarean section for all the patients with breech presentation if there are no contraindicationsView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effects of external cephalic version for breech presentation at or near term in high-resource settings: A systematic review of randomized and non-randomized studies.

INTRODUCTIONExternal cephalic version (ECV) for breech presentation involves manual manipulation of the fetus from breech to cephalic presentation at or near term, in an attempt to avoid breech birth. This systematic review summarizes the literature on the effects of ECV at or near term on pregnancy outcomes in high-resource settings.METHODSThe MEDLINE, Embase, CINAHL, Cochrane Library, MIDIRS, and SweMED+ databases were searched for relevant articles published through April 2019, with no limitation on publication date. Clinical trials comparing the effects of ECV at ≥36 weeks, with or without tocolysis, with that of no ECV, conducted in northern, western, and central Europe, the USA, Canada, Australia, and New Zealand were eligible for inclusion.RESULTSNine articles reporting on 184704 breech pregnancies were included. Pooled data showed that ECV attempts reduced the failure to achieve vaginal cephalic birth (risk ratio, RR=0.56; 95% CI: 0.45–0.71), caesarean section performance (RR=0.57; 95% CI: 0.50–0.64), and non-cephalic presentation at birth (RR=0.45; 95% CI: 0.29–0.68) compared with no ECV. ECV attempts also increased the incidence of Apgar score <7 at 5 minutes (RR=1.29; 95% CI: 1.10–1.52).CONCLUSIONSWomen for whom ECV is attempted at or near term are at reduced risk of caesarean section, non-cephalic presentation at term, and failure to achieve vaginal cephalic birth. Compared with no ECV, attempted ECV was also associated with a slightly increased risk of a low Apgar score at 5 minutes. The evidence is limited by the scarcity of high-quality research and the presence of risks of bias.

External cephalic version without anaesthesia for breech presentation in singleton term pregnancies: a retrospective analysis of 195 cases

Objective To investigate the safety and effectiveness of external cephalic version for breech presentation in singleton term pregnancies. Methods This study retrospectively analyzed the clinical data of 195 singleton pregnancies with gestational weeks ≥37 and breech presentation that has received external cephalic version in University of Hong Kong-Shenzhen Hospital from January 2014 to December 2016. The success rate of external cephalic version, delivery modes, maternal and neonatal complications and adverse outcomes were analyzed. Results Of the 195 cases, 62.6% (122/195) were successful, among which 107 vaginally delivered and 15 underwent the cesarean section. Maternal and neonatal outcomes of all 195 cases were good. The success rate of external cephalic version in the multipara was higher than that of the primipara [84.5%(71/84) vs 45.9%(51/111), χ2=30.383, P<0.001]. No neonatal asphyxiation or postpartum hemorrhage was reported. Conclusions External cephalic version is an effective and safe method to convert breech presentation and reduce cesarean section rate in the third trimester. Key words: Version, fetal; Breech presentation; Retrospective studies

Coming out ahead: the cost effectiveness of external cephalic version using spinal anesthesia

Breech presentation is encountered in 3 to 4% of term pregnancies and has been a significant driver of the increased rate of cesarean deliveries over the last 4 decades. External cephalic version (ECV) is recommended at term by most professional organizations in an effort to reduce the prospect of cesarean deliveries. The authors propose the use of regional anesthesia to increase efficacy and reduce cost in the care of patients who undergo ECV in an effort to convert a breech presentation to a vertex counterpart. Despite emerging evidence of the advantages, obstacles to more comprehensive implementation of this approach continue to exist, which include patient acceptance, provider experience, and safety concerns. The addition of tocolytics and use of regional anesthesia for secondary ECV efforts have also been considered as options to increase success and reduce cost. This is a commentary on http://www.ijhpr.org/content/3/1/5.

Women’s Experiences of Participating in the Early External Cephalic Version 2 Trial

The international, multicenter External Cephalic Version 2 (ECV2) Trial compared early external cephalic version at 34(0/7) to 35(6/7) weeks with that at greater than 37 weeks. A total of 1,543 women were randomized from 68 centers in 21 countries. The goal of this component of the trial was to understand women's views about participation in a research trial and timing of external cephalic version. A postpartum questionnaire was completed containing a 5-point Likert scale examining contact and availability of staff, choice of timing of external cephalic version, preference of randomization, convenience of participating, and overall satisfaction. Participants also completed two open-ended questions related to timing of external cephalic version and satisfaction with the trial. Descriptive statistics and content analysis were used to analyze data. A total of 1,458 women completed the questionnaire, of whom 86 percent said "yes"-they would participate in the trial again. Themes influencing decisions about participating were perceptions of the external cephalic version experience, preferred mode of delivery, preferred timing of external cephalic version, and perceptions of the effectiveness of external cephalic version and of the trial environment. Many participants preferred the early timing of the procedure offered through the trial because of perceived advantages of a smaller baby being easier to turn and the opportunity for repeat procedures. Women were positive about their participation in the trial. Early external cephalic version was preferred over the traditional timing as it was perceived to afford both physiologic and practical advantages.

A retrospective study of the success, safety and effectiveness of external cephalic version without tocolysis in a specialised midwifery centre in the Netherlands

Background to evaluate the effectiveness of external cephalic version (ECV) without tocolysis or epidural analgesia, the complications associated with the procedure and the association between the number of ECV attempts and cephalic presentation at birth and caesarean section. Methods retrospective cohort study of all ( n = 924 ) ECVs carried out between 1996 and 2000 in a specialised midwifery centre in the Netherlands. After bivariate analysis, those variables with a p value under 0.05 were considered statistically significant and were tested in a logistic regression model using backward stepwise selection. Analyses were carried out separately for first ECV attempts and second ECV attempts. Findings in total, 958 ECVs were analysed, 889 first attempts and 69 repeat attempts. Seventy per cent of all first ECVs were carried out before 37 weeks, but half of those were carried out between 36 and 37 weeks. The success rate for first ECV was 41% and for the second ECV 29%. Bivariate analysis showed that the success of the first ECV was positively influenced by parity, non-Dutch origin, higher birth weight, higher age and longer duration of pregnancy. After logistic regression, parity (odds ratio [OR] 2.8, 95% CI 2.1 to 3.7), non-Dutch origin (OR 1.8, 95% CI 1.2 to 2.8) and birth weight (OR 1.7, 95% CI 1.4 to 2.0) remained factors that independently influenced the success of ECV. The odds ratio for duration of pregnancy at first ECV was borderline significant: OR 1.2 (1.0 to 1.4). After an unsuccessful first ECV, only 13% of the women received a second ECV. The prevalence of cephalic presentation at birth increased with 3% after a second ECV. Three cases of complications were reported during or very shortly after the first ECV, and these did not result in serious complications. No complications were reported after a second ECV. Conclusion ECV without tocolysis is a safe procedure for pregnant women and their babies. Repeat ECV increases the number of cephalic presentations at birth and should be considered after an unsuccessful ECV.

Version par manœuvre externe: Expérience à la maternité Port-Royal à partir de 237 versions

To evaluate the effectiveness of external cephalic version for reducing the rate of cesarean section by preserving fetal safety. A retrospective review of 237 external cephalic versions between January 1, 1998 and December 31, 2000 was conducted at Port Royal maternity. The success rate of external cephalic version was 50.6%. When version failed vaginal birth could be allowed after strict evaluation. The rate of cesarean section was 12.5% in the success group and 53% in the unsuccessful group, two thirds were planned. The overall rate of vaginal birth among breech presentations was 67%. After version there were 3.4% abnormal fetal heart rate tracings and 2.9% positive Kleihauer tests. No major complications occurred. Successful external cephalic version was associated with statistically significant higher multiparity, complete breech out of the pelvis and normal amniotic fluid Volume. External cephalic version reduces the cesarean section rate by about 20.5% among breech presentations and so, lowers maternal morbidity. External cephalic version could be proposed to the patients when safety criteria are respected and close fetal monitoring is maintained.

Effect of external cephalic version at term on fetal circulation

Objective: We sought to investigate the subclinical effect of external cephalic version on fetal circulation. Study Design: A prospective observational study was conducted on 136 subjects who had external cephalic version at or beyond 36 weeks of gestation without clinical complication. Doppler ultrasonographic studies of the umbilical and middle cerebral circulations were performed before and after the external cephalic version. The following Doppler indexes were measured: (1) the pulsatility index of the umbilical artery, which represents disturbance of placental circulation, and (2) the pulsatility index of the fetal middle cerebral artery, which represents fetal response. The Wilcoxon signed rank test was used for all statistical analyses. Results: There was no significant difference in pulsatility index of the umbilical artery before and after external cephalic version ( P = .674). There was a statistically significant reduction in the pulsatility index of the middle cerebral artery after external cephalic version ( P = .043), and this difference existed only among multiparous women ( P = .029), among those in whom the external cephalic version was considered to be difficult ( P = .038), and when the placenta was posteriorly located ( P = .028). The reduction in pulsatility index was not related to whether the external cephalic version was successful. In all cases the Doppler indexes remained within the normal ranges, and there were no associated fetal complications. Conclusion: External cephalic version was not associated with any significant disturbance of placental resistance to blood flow. Conversely, external cephalic version was associated with a significant reduction in the pulsatility index of the middle cerebral circulation, especially among the multiparous women, after a difficult procedure or in those with a posterior placenta. This probably represents a normal fetal physiologic response to manipulation of the fetal head. (Am J Obstet Gynecol 2000;182:1239-42.)

Determining cost savings from attempted cephalic version in an inner city delivering population.

The use of external cephalic version (ECV) is increasingly seen as an important clinical management strategy for breech presentation infants. Currently, 75% of women with breech presentation at term undergo Cesarean delivery risking adverse outcomes and incurring higher costs. ECV, if successful, reduces the rate of breech presentation at delivery and the need for Cesarean delivery. Data from an inner-city population of delivering women were examined to determine the effectiveness of ECV among these minority, low income women. Hospital clinical and Medicaid claims data for 679 deliveries with breech presentation were studied. Decision tree analysis indicated ECV was successful for 48% of those attempted. Based on amounts billed Medicaid, attempting ECV reduced the use of resources by a little over $3,000 per delivery. Sensitivity analysis showed, however, that the savings may be as low as $906. Multivariate analysis confirmed the independent effect of attempting ECV on the probability of Cesarean delivery.

External cephalic version for breech presentation before term.

Management of breech presentation is controversial, both in regard to manipulation of the position of the fetus and the method of delivery. External cephalic version may reduce the number of breech presentations and caesarean sections, but there also have been reports of increased perinatal mortality with the procedure. The objective of this review was to assess the effects of external cephalic version for breech presentation before term on measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: October 1997. Randomised and quasi-randomised trials of external cephalic version before term (37 weeks gestation) compared with a control group in women with breech presentation before term. Eligibility and trial quality were assessed by the reviewer. Three studies involving 889 women were included. There was no significant effect of external cephalic version before term on the following: non-cephalic presentation (relative risk 1.02, 95% confidence interval 0.89 to 1.17); caesarean section (relative risk 1.10, 95% confidence interval 0.78 to 1.54); low Apgar scores (relative risk 0.81, 95% confidence interval 0.44 to 1.49); perinatal mortality (relative risk 1.19, 95% confidence interval 0.46 to 3.05). External cephalic version before term does not appear to improve pregnancy outcomes.

External cephalic version for breech presentation at term.

Management of breech presentation is controversial, both in regard to manipulation of the position of the fetus and the method of delivery. External cephalic version may reduce the number of breech presentations and caesarean sections, but there also have been reports of increased perinatal mortality with the procedure. The objective of this review was to assess the effects of external cephalic version at term on measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth trials register was searched. Date of last search: October 1997. Randomised trials of external cephalic version at term (with or without tocolysis) compared with no attempt at external cephalic version in women with breech presentation. Eligibility and trial quality were assessed by GJH and checked by RK. Six studies were included. External cephalic version at term was associated with a significant reduction in non-cephalic births (relative risk 0.42, 95% confidence interval 0.35 to 0.50) and caesarean section (relative risk 0.52, 95% confidence interval 0.39 to 0.71). There was no significant effect on perinatal mortality (relative risk 0.44, 95% confidence interval 0.07 to 2.92). Attempting cephalic version at term appears to reduce the chance of non-cephalic births and caesarean section. There is not enough evidence to assess any risks of external cephalic version at term.

The benefit of external cephalic version with tocolysis as a routine procedure in late pregnancy

The effectiveness of external cephalic version with tocolysis when routinely used in the 37th week of gestation is reported. The procedure had earlier been ruled out in our department, was found effective in a prospective study, and afterwards settled as a routine. Among 1038 women with single breech presentation, 882 could be offered an attempt of external cephalic version during the period 1982–1988. Attempt of version was carried out in 316 women resulting in a vertex presentation at delivery in 100. The success rate on average was 35%. The estimated reduction of breech deliveries was 100 1038 = 9.6% . As the mean caesarean section rate in women with breech presentation was 81% during the period studied, the estimated reduction in the number of caesarean sections during those seven years was 81. Thus the total caesarean section rate (11.3%) was estimated to be reduced by 0.4%. No immediate serious complications were associated with the procedure. Two cases of intra-uterine fetal death occurred 2 and 5 weeks, respectively, after successful, uncomplicated version to vertex presentation. No obvious connection with the external cephalic version could be demonstrated. The effectiveness of version as a routine procedure is less than expected from reports of prospective trials of external cephalic version carried out by a few investigators, but the results may realistically illustrate what is achieved in the long term.

Effect of External Cephalic Version in Late Pregnancy on Presentation at Delivery

VAN VEELEN, A. J.; VAN CAPPELLEN, A. W.; FLU, P. K.; STRAUB, M. J. P. F.; WALLENBURG, H. C. S. Author Information

Effect of External Cephalic Version in Late Pregnancy on Breech Presentation and Cesarean Section Rate

Effect of External Cephalic Version in Late Pregnancy on Breech Presentation and Cesarean Section Rate