External Cephalic Version Group Research Articles

Retrospective Analysis of Pregnancy Outcomes Following External Cephalic Version for Breech Presentation.

We explored the feasibility and safety of external cephalic version (ECV) for cases of breech presentation. We retrospectively analyzed data from 158 singleton pregnant women with breech presentation at 36 weeks gestation, admitted to Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2018 to March 2022. 42 underwent ECV, categorized as the ECV group, while 116 without ECV comprised the control group. Systematic collection and evaluation of pregnancy outcomes were conducted for both groups. Within the control group, 16 cases experienced a spontaneous transition to head presentation, among which 14 cases resulted in successful vaginal deliveries. In 2 cases, cesarean deliveries were performed due to fetal macrosomia and persistent posterior occipital presentation. Furthermore, 2 cases of breech presentation in pregnant women were successfully delivered vaginally through breech traction, necessitating an emergency procedure due to the wide opening of the uterus. Within the ECV group, 28 cases were successfully inverted to the cephalic presentation. Among them, 1 case underwent an emergency cesarean delivery due to fetal distress during cephalic delivery, 3 cases required cesarean deliveries due to abnormal labor, and 24 cases were successfully delivered vaginally. The comparative analyses showed that the cesarean section rate (18/42 vs 100/116) and non-cephalic delivery rate (14/42 vs 100/116) in the ECV group were significantly lower than those in the control group (P < 0.001). There was no statistically significant differences between the two groups with respect to the rate of newborns with Apgar score < 7 (1/42 vs 3/116), premature rupture of membrane (3/42 vs 20/116), acute fetal distress (2/42 vs 2/116), and cord prolapse (0/42 vs 1/116) (P > 0.05). ECV can effectively reduce the rate of cesarean delivery and non-cephalic deliveries. However, it but requires strict adherence to indications and continuous monitoring.

External cephalic version for a malpresenting first twin before labor: a prospective case series

In twin pregnancies where the presenting twin is not cephalic, cesarean delivery is the standard of care. External cephalic version (ECV) has been used for malpresenting singleton pregnancies with low risk of complications. ECV in twin pregnancies is poorly studied. To assess feasibility and report any complications of ECV of a malpresenting twin before labor. This is a prospective cohort of twin pregnancies with malpresenting first twin. Inclusion criteria included English or Spanish speaking women. Exclusions included cases where there was a contraindication to vaginal delivery. ECV was performed according to the institutional singleton protocol. Fetal testing of both twins was performed before and after procedure. A vaginal hand was used during ECV as needed. The primary outcome was success of the procedure. Secondary outcomes included delivery characteristics and neonatal outcomes. Five patients were enrolled in this study. Four patients underwent successful ECV and vaginal delivery occurred in 2 of the 4 patients. ECV procedure was performed at a mean gestational age of 36+0 weeks in the successful ECV group and 36+6/7 weeks for the unsuccessful group. Latency to delivery was 4.5 days in the successful ECV group and 1 day in the unsuccessful ECV group. No maternal or neonatal complications occurred in any participating women. ECV in twin pregnancies where the first twin is malpresenting was feasible in our cohort. More research is needed to better characterizer the safety and efficacy of this procedure in this patient population.

Perinatal Outcomes After Undergoing External Cephalic Version

: The external cephalic version (ECV) represents the standard for pregnancies at term with a non-cephalic presentation as it avoids planned caesareans. The aim of this study was to assess the caesarean rate and prognostic factors at birth after undergoing ECV, which was compared with scheduled caesareans for a non-cephalic presentation (SCG) and spontaneous cephalic presentations at birth (GG). No difference was observed between the caesarean rate of the ECV (n=65) and the GG (n=3711) groups (9.84% and 14.47%, respectively, p-value=0.30), and neither was found between the ECV group and both the GG and SCG (n=76) groups in the Apgar scores and postpartum pH, but for the five-minute Apgar score (9.98 and 9.84 in the ECV and SCG groups, respectively, p-value=0.04). This study provides further evidence for clinical practice regarding good perinatal outcomes after undergoing ECV. Further research is required to consistently prove the increase in the intrapartum caesarean rate after ECV that has been previously described in the literature, which has not been found in the present study. Keywords: External Cephalic Version, Breech Presentation, Caesarean Rate, Perinatal Outcomes, Apgar Score, Postpartum Ph.

Late preterm versus term external cephalic version: an audit of a single obstetrician experience.

Recent literature evaluating the optimal timing for external cephalic version (ECV) in non-cephalic presentation is limited and hampered by methodological issues. We aimed to compare late preterm ECV [term (36-37weeks of gestation] to term ECV ( > 37weeks). We conducted a retrospective cohort study of prospectively collected data of ECV procedures performed by a single operator during a 6year period. Maternal, ECV procedure, delivery and fetal characteristics were compared between preterm ECV and term ECV. Overall, 547 (91.6%) of ECVs were term ECV while 50 (8.4%) procedures were preterm ECV. Success rate of ECV was 72.0% in the preterm ECV group vs. 71.5% in the term ECV group, p = 0.93. Proportion of preterm delivery was higher among the preterm ECV group (8% vs. 0%, p < 0.001), so does the proportion of early term deliveries (36.0% vs. 22.8%, p = 0.03). The rate of low birth weight was higher among the preterm ECV group (10.0% vs. 3.11%, p = 0.01). Rates of Apgar score at 5min ≤ 8 were higher in the preterm ECV (4.0% vs. 0.5%, p = 0.007). Vaginal delivery and intrapartum cesarean delivery rates did not differ between study groups (72.0% vs. 73.2%, p = 0.83 and 10% vs. 8.4%, p = 0.69). Initiating ECV before term is associated with increased rate of preterm delivery, early term delivery and low birth weight. No effect was found in mode of delivery, intrapartum cesarean delivery, reversion and spontaneous version. We advocate against preterm ECV until future prospective trials will better delineate the effect of preterm ECV on maternal and neonatal outcomes.

Success rates of early versus late initiation of external cephalicversion.

To determine optimum timing of external cephalic version (ECV). A retrospective cohort study was conducted at a tertiary hospital in Israel between February 1, 2016, and July 1, 2017. Healthy primiparous women with breech presentation were offered either early ECV (35-36weeks; n=54) or late ECV (37-38weeks; n=106). Group assignment was according to the patient's preference and physician availability. The primary outcome was the rate of cephalic presentation at delivery. Secondary outcomes included rate of cesarean delivery, presentation of fetus after the first and last ECVs, and serious fetal complications. The incidence of undergoing more than two ECV attempts was 18.5% in the early ECV group and 5.6% in the late ECV group (P=0.039). The incidence of cephalic presentation after the first ECV was 72.2% in the early ECV group versus 66.0% in the late ECV group (P=0.048). By contrast, no statistically significant between-group differences were found for presentation at delivery or rate of cesarean delivery. The other outcomes were also similar. Early initiation of ECV among primiparous women increased the chance of immediate cephalic presentation; however, it had no effect on presentation at delivery or cesarean delivery rate.

807: A Novel prediction model for external cephalic version success

Breech presentation accounts for 3% to 4% of term pregnancies. Breech vaginal delivery has become less accepted following the publication of the Term Breech Trial in 2000. Successful external cephalic version (ECV) can reduce the rates of non-cephalic delivery and cesarean section (CS), but does not lack complications. Currently, maternal consultation on ECV success is limited to quoted success rates, varying from 35-83% in different studies. Clinical predictive factors have been identified for successful ECV, but have yet to be integrated in a predictive model, potentially assisting in the precise counselling of gravidas with non-cephalic presentation. A case-control study of patients who underwent ECV from January 2011 to July 2018, at a single tertiary center. Successful ECV was compared in a single and multivariate analysis using demographic and clinical independent variables to failed ECV group. A model predicting ECV success algorithm was assembled based on probability calculations extracted from the multivariate analysis. 701 women underwent ECV during the study period. ECV success rate was 60.34%. Characteristics of success & failure groups are shown on Table 1. Complication rate was 7.7% (n=54), of which 77.7% (n=42) were transient changes in fetal heart rate, 0.28% (n=2) suspected abruption and one case of neonatal anemia following ECV. Emergency post procedural CS rate was 1.2%. There were no cases of fetal demise. Positive predictors of successful ECV were Parity ≥1 (RR=4.55, CI 3.19-6.49), AFI≥200mm (RR=2.4, CI 1.33-4.46). Anterior placentation and maternal weight ≥ 70 kg were found to be negative predictors (RR=0.34, CI 0.236-0.479 and RR=0.59, CI 0.41-0.85 respectively). Subsequently a prediction algorithm was built on probability calculations based on the 4 predictors of ECV success; parity (0 or ≥1), AFI (<100, 100-200, >200), placentation (anterior, non-anterior) and maternal weight (<70kg, ≥70 kg). Use of the predictive model enabled excellent prediction of patient specific ECV success rates from 7% up to 95%. An algorithm for prediction of successful ECV based on clinical maternal parameters is presented.

Impact de la version par manœuvre externe sur le pronostic obstétrical dans une équipe à fort taux de réussite de l’accouchement vaginal du siège

To analyse the impact of external cephalic version (ECV) on caesarean section rate in a team with a high success rate of vaginal delivery in breech presentation. Retrospective monocentric study including 298patients with a breech presentations between 33 and 35weeks of amenorrhea followed at our university hospital and delivered after 35weeks, between 1stJanuary2011 and 31stDecember2013. Patients were divided into 2groups: planned ECV (n=216patients) versus no planned ECV (n=57patients). Our rate of successful vaginal breech delivery over the period of the study was 61.1%. We performed 165ECV, with a 21.8% success rate. The average term of the attempt of ECV was 36.7weeks of amenorrhea. The caesarean section rate was not significantly different in the planned ECV group, even after adjustment on age, parity and previous caesarean delivery (adjusted OR=1.67 [0.77-3.61]). Attempt of ECV did not reduce the number of breech presentation at delivery (61.1% versus 61.4% [P=0.55]). Planned ECV in our center with a high level of breech vaginal delivery did not significantly impact our cesarean section rate.

Intrapartum intervention rates and perinatal outcomes following successful external cephalic version.

To determine intrapartum and perinatal outcomes following successful external cephalic version for breech presentation at term. This was a retrospective cohort study of outcomes following successful external cephalic version in 411 women at an Australian tertiary maternity unit between November 2008 and March 2015. The study cohort was compared with a control group of 1236 women with cephalic presentation who underwent spontaneous labor. Intrapartum intervention rates and adverse neonatal outcomes were compared between both groups. The success rate of external cephalic version (ECV) was 66.4%. The spontaneous vaginal delivery rate in the study cohort was 59.4% (224/411) vs 72.8% (900/1236) in the control cohort (P<0.001). Intrapartum intervention rates (emergency cesarean section (CS) and instrumental delivery) were higher in the ECV group (38% vs 27.2%, P<0.001). Rates of emergency CS for non-reassuring fetal status (9.5%, 39/411 vs 4.4%, 54/1236, P⩽0.001) and failure to progress (13.4%, 55/411 vs 4.1%, 51/1236, P<0.001) were higher in the study cohort. Neonatal outcomes were worse in the study cohort-Apgar score <7 at 5 min (2.2%, 9/411 vs 0.6%, 8/1236, P<0.001) and abnormal cord gases (8.5%, 35/411 vs 0.2%, 3/1236, P<0.001). Rates for resuscitation at birth and admission to the neonatal intensive care unit were higher in the study cohort (6.1% vs 4.1% and 1.9% vs 1.1%, respectively) but these were not statistically significant. Labor following successful ECV is more likely to result in increased intrapartum intervention rates and poorer neonatal outcomes.

External cephalic version for breech presentation before term.

External cephalic version (ECV) of the breech fetus at term (after 37 weeks) has been shown to be effective in reducing the number of breech presentations and caesarean sections, but the rates of success are relatively low. This review examines studies initiating ECV prior to term (before 37 weeks' gestation). To assess the effectiveness of a policy of beginning ECV before term (before 37 weeks' gestation) for breech presentation on fetal presentation at birth, method of delivery, and the rate of preterm birth, perinatal morbidity, stillbirth or neonatal mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies. Randomised controlled trials (RCTs) of ECV attempted before term (37 weeks' gestation) or commenced before term, compared with a control group of women (in breech presentation) in which either no ECV attempted or ECV was attempted at term. Cluster-randomised trials were eligible for inclusion but none were identified. Quasi-RCTs or studies using a cross-over design were not eligible for inclusion. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. Studies were assessed for risk of bias and for important outcomes the overall quality of the evidence was assessed using the GRADE approach. Five studies are included (2187 women). It was not possible for the intervention to be blinded, and it is not clear what impact lack of blinding would have on the outcomes reported. For other 'Risk of bias' domains studies were either at low or unclear risk of bias.One study reported on ECV that was undertaken and completed before 37 weeks' gestation compared with no ECV. No difference was found in the rate of non-cephalic presentation at birth (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.64 to 1.69; participants = 102). One study reported on a policy of ECV that was initiated before term (33 weeks) and up until 40 weeks' gestation and which could be repeated up until delivery compared with no ECV. This study showed a decrease in the rate of non-cephalic presentation at birth (RR 0.59, 95% CI 0.45 to 0.77; participants = 179).Three studies reported on ECV started at between 34 to 35 weeks' gestation compared with beginning at 37 to 38 weeks' gestation. Pooled results suggested that early ECV reduced the risk of non-cephalic presentation at birth (RR 0.81, 95% CI 0.74 to 0.90; participants = 1906; studies = three; I² = 0%, evidence graded high quality), failure to achieve vaginal cephalic birth (RR 0.90, 95% CI 0.83 to 0.97; participants = 1888; studies = three; I² = 0%, evidence graded high quality), and vaginal breech delivery (RR 0.44, 95% CI 0.25 to 0.78; participants = 1888; studies = three; I² = 0%, evidence graded high quality). The difference between groups for risk of caesarean was not statistically significant (RR 0.92, 95% CI 0.85 to 1.00; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was evidence that risk of preterm labour was increased with early ECV compared with ECV after 37 weeks (6.6% in the ECV group and 4.3% for controls) (RR 1.51, 95% CI 1.03 to 2.21; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was no clear difference between groups for low infant Apgar score at five minutes or perinatal death (stillbirth plus neonatal mortality up to seven days) (evidence graded as low quality for both outcomes). Compared with no ECV attempt, ECV commenced before term reduces non-cephalic presentation at birth. Compared with ECV at term, beginning ECV at between 34 to 35 weeks may have some benefit in terms of decreasing the rate of non-cephalic presentation, and risk of vaginal breech birth. However, early ECV may increase risk of late preterm birth, and it is important that any future research reports infant morbidity outcomes. Results of the review suggest that there is a need for careful discussion with women about the timing of the ECV procedure so that they can make informed decisions.

Success rate and influencing factors of external cephalic version for breech presentation

Objective To discuss the success rate of external cephalic version (ECV) for breech presentation in singleton pregnancies and the factors influencing ECV,and complications induced by ECV.Methods A prospective study was conducted which included 204 pregnant women who underwent regular prenatal examinations and delivered in Nanjing Drum Tower Hospital between March 1,2011 and February 29,2012.The 204 cases were single pregnancy with breech presentation identified by ultrasound during 32-37+6 weeks of gestation,and without other indications for cesarean section (CS).According to willingness of the participants,204 cases were divided into two groups.The 101 pregnant women who refused EVC (control group) were asked to practice knee-chest position twice a day; and 103 pregnant women volunteered to undergo EVC (ECV group) during 32-37+6 weeks of gestation.The proportion of cephalic presentation at delivery,CS rate and the incidence of PROM,premature delivery and cord around the neck were compared between the two groups.Factors influencing the success rate of ECV were analyzed.Chi-square or adjusted Chi-square test were used for statistical analysis.Results The proportion of cephalic presentation at delivery in the ECV group was higher than that in the control group [68.9％ (71/103) vs 29.7％ (30/101),x2=31.39]; the CS rate in the ECV group was lower than that in the control group [49.5％ (51/103) vs 78.2％ (79/101),x2=18.18],as was the rate of CS due to breech presentation [62.7％ (32/51) vs 89.9％ (71/79),x2=13.86],all P＜0.05.The success rates in frank breech presentation,complete breech presentation and incomplete breech presentation were 77.1％ (37/48),72.7％ (24/33) and 45.5％ (10/22),respectively (x2=7.37,P＜0.05),and the success rate in frank breech presentation was higher than that in incomplete breech presentation (x2=6.84,P＜0.017).No significant differences were observed in the success rates between primiparas and multiparas [67.7％ (63/93) vs 8/10,x2=0.19],placenta attached at front wall of uterus and other attachment sites [61.0％ (25/41) vs 74.2％ (46/62),x2=2.01],and EVC performed at 32-35+6weeks of gestation and 36-37+6 weeks [70.5％ (62/88) vs 9/15,x2=0.65],allP＞0.05.No significant differences were observed for the incidence of PROM [7.8％ (8/103) vs 6.9％ (7/101)],premature delivery [2.9％ (3/103) vs 2.0％ (2/101)] and cord around the neck [17.5％ (18/103) vs 21.8％ (22/101)] between the ECV and control group (x2=0.05,0.19 and 0.60,all P＞0.05).Conclusions ECV for breech presentation in singleton pregnancies can effectively correct the fetal position and reduce the CS rate.ECV performed after 32 weeks of gestation does not increase the risk of PROM and premature delivery. Key words: Breech presentation; Version, fetal; Fetal membranes, premature rupture; Premature birth

Editor’s Choice

Editor’s Choice

Cord Blood Acid-Base Status at Delivery After Successful External Cephalic Version

Pregnancies after successful external cephalic version (ECV) are generally regarded as being normal. Nevertheless, increased levels of thyroid-stimulating hormone, an indicator of perinatal stress, recently were reported in cord blood in infants delivered vaginally after successful ECV. This retrospective study was an attempt to learn whether such infants are compromised, in particular, whether there are abnormalities of acid-base balance in cord blood. The 89 study cases were singleton deliveries at or after 37 weeks gestation that followed successful version. The same number of pregnancies with spontaneous cephalic presentation made up the control group. Women in the ECV group were significantly older, but there were no significant differences in birth weights or Apgar scores. Women in the ECV group had significantly more emergency cesarean deliveries than did control women. Cord blood arterial and venous acid-base parameters were similar in the 2 groups, as were the proportions of fetuses with a cord blood pH less than 7.20. Even after adjusting for maternal age, gestational age at delivery, mode of delivery, birth weight, spontaneous or induced labor, and duration of labor, differences in cord blood pH between the ECV and control groups were not significant. These findings support the use of ECV for term breech presentation. These infants may be more vulnerable biologically to the stress of labor, but with adequate intrapartum care, they should not be at increased risk of being acidotic at the time of birth. ECV may entail more emergency section deliveries, but it does lessen the incidence of cesarean deliveries for breech pregnancies.

External cephalic version beginning at 34 weeks' gestation versus 37 weeks' gestation: A randomized multicenter trial

Objective: In about 3% to 4% of all pregnancies at term, the fetal presentation will be noncephalic. External cephalic version (ECV) at term has been shown to decrease the rate of noncephalic presentation at birth and to decrease the rate of cesarean section associated with breech presentation. However, success rates for ECV are low. We did a randomized trial to compare a policy of beginning ECV early, at between 34 and 36 weeks' gestation, and beginning ECV at 37 to 38 weeks' gestation. Study Design: At 25 centers in seven countries, 233 women with a singleton breech fetus were randomly assigned to having an ECV procedure done early (at between 34 weeks 0 days and 36 weeks 0 days), or delayed (at between 37 weeks 0 days and 38 weeks 0 days). An experienced practitioner undertook the ECV procedure, and repeat ECV procedures were allowed. Tocolytics and use of epidural analgesia were included as part of the protocol. The primary outcome was the rate of noncephalic presentation at birth. An intention-to-treat analysis was used. Results: Data were received for 232 women, with 116 women in each of the early and delayed ECV groups. Of these, 86.2% in the early ECV group and 67.2% in the delayed ECV group had at least one ECV performed. The rate of noncephalic presentation at birth in the early ECV group was 66 of 116 (56.9%) and 77 of 116 (66.4%) in the delayed ECV group (relative risk [RR] [95% CI] 0.86 [0.70-1.05], P =.09). The rate of serious fetal complications and the rate of preterm birth at <37 weeks were not significantly increased in the early ECV group compared with the delayed ECV group (6.9% vs 7.8%, RR [95% CI] 0.89 [0.36-2.22], P =.69 and 8.6% vs 6.1%, RR [95% CI] 1.42 [0.56-3.59], P =.31, respectively). The rate of cesarean section in the early ECV group was 75 of 116 (64.7%) and 83 of 116 (71.6%) in the delayed ECV group (RR [95% CI] 0.90 [0.76-1.08], P =.32). Neonatal outcomes were comparable in the two groups. The rate of reversion to noncephalic was low in both groups. The majority of women in both groups indicated that they would consider having an ECV in another pregnancy. Conclusion: Early ECV performed at 34 to 36 weeks compared with 37 to 38 weeks may reduce the risk of noncephalic presentation at delivery. A large pragmatic trial of early ECV is now required to assess this approach further in terms of cesarean section rates and neonatal outcomes before changes in clinical practice. (Am J Obstet Gynecol 2003;189:245-54.)

High Incidence of Obstetric Intervensions After Successful External Cephalic Version

There is no doubt that external cephalic version (ECV), done at or near term, lowers the need for cesarean delivery in women with a breech presentation. The outcome of labor after successful version is, however, not as clear. Labor outcomes therefore were examined in a retrospective series of 279 consecutive singleton pregnancies delivering at term, in all instances after successful ECV. A control group included 28,447 singleton term deliveries seen in the same 6-year review period (1995-2000). A large majority of parturients were ethnic Chinese. Reasons for exclusion from the series included an existing uterine scar, preexisting medical disease, any noncephalic presentation at birth, and a gestational age at birth of less than 36 completed weeks. In the study group, the median time from ECV to delivery was 16½ days. Labor was induced significantly more frequently in the ECV group because of postterm status, a suspicious or abnormal fetal heart record, or bleeding of unknown origin. Routine ultrasound studies did not lower the need for postterm induction, but an abnormal cardiotocogram was no longer a significant precedent of induction after excluding women with a suspicious or abnormal record immediately after ECV. Five women had labor induced immediately after version because of a transverse or unstable lie at term. Labors lasted about as long in the ECV group as in the control group, but more of those in the ECV group required epidural analgesia and surgical augmentation. Both instrumental and cesarean deliveries were more frequent in ECV women. The increased risk of operative delivery remained after adjusting for numerous potentially confounding variables, including maternal age and height, parity, maturity, birth weight, labor induction, and the duration of labor. There do seem to be differences in labor between women having successful ECV and those with spontaneous cephalic presentation. The former women are likelier to undergo various obstetrical interventions, including cesarean delivery, and they should be aware of this risk before agreeing to ECV.

High incidence of obstetric interventions after successful external cephalic version

Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case–control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann–Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3% vs 12.8%; OR 1.4; 95% CI 1.0–2.0, and 23.3% vs 9.4%; OR 3.1; 95% CI 2.3–4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0% vs 13.4%; OR 2.0; 95% CI 1.5–2.7) and use of epidural analgesia (20.4% vs 12.4%; OR 1.8; 95% CI 1.4–2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions.

High incidence of obstetric interventions after successful external cephalic version

To investigate the delivery outcome after successful external cephalic version (ECV). Case-control study. University teaching hospital. The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Between group differences were compared with the Mann-Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3% vs 12.8%; OR 1.4; 95% CI 1.0-2.0, and 23.3% vs 9.4%; OR 3.1; 95% CI 2.3-4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0% vs 13.4%; OR 2.0; 95% CI 1.5-2.7) and use of epidural analgesia (20.4% vs 12.4%; OR 1.8; 95% CI 1.4-2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions.

A prospective randomized trial of the use of epidural anesthesia during external cephalic version

Objective: To determine if the use of epidural anesthesia improves the success rate of external cephalic version (ECV). Design: Women identified with a singleton fetus in a breech or transverse presentation at a gestational age of ≥37 weeks gestation were offered enrollment in this prospective randomized trial. Inclusion criteria included maternal age of 18 years or older, a non-vertex presentation confirmed by ultrasound, a reactive fetal non-stress test, and an estimated fetal weight of 2,000–4,000 g. A 1:1 randomization was accomplished through a computer-generated random numbers table with group assignments sealed in sequentially numbered opaque envelopes. Women in the epidural ECV group had a lumbar epidural catheter inserted through which 2% lidocaine and 100 μg of fentanyl were infused. Results: There were no statistically significant differences between the two groups in gestational age at ECV, placental location, fetal lie, gravidity or parity, estimated fetal weight, or amniotic fluid index. The ECV was successful in 26 of 45 (58%) women with epidural anesthesia compared to 16 of 48 (33%) with no anesthesia (relative risk 1.7, 95% confidence interval 1.1–2.8, P < .05). Fetal bradycardia resulting in discontinuation of the version efforts occurred in two patients in the epidural group and three women in the control population, a non-statistically significant difference. There were no maternal complications noted in the study population related to the epidural anesthesia. Conclusions: The use of epidural anesthesia increases the success rate of external cephalic version.

Outcome of external cephalic version: our experience.

The aim is to assess the outcome of external cephalic version (ECV) for term breech in our clinical setting and the factors involved. Patients with no contraindications and who consented to ECV were recruited into this prospective study. Terbutalin infusion was used. There were 42 ECV attempts of which 21 (50%) were successful. Seventeen of the patients with successful ECV delivered vaginally and 4 had cesarean section for various indications. Only 5 of the 21 unsuccessful ECV delivered vaginally. Thirteen had elective cesarean section and 2 had emergency cesarean during trial of breech. One patient from the unsuccessful ECV group was lost to follow-up. There were 31 (74%) primipara. The birth weight of the babies was not a significant factor in the outcome of ECV. The type of breech and parity did influence the success rate. External cephalic version should be included in the routine management of our breech presentation.