Outcome Of External Cephalic Version Research Articles

Maternal thyroid function and the outcome of external cephalic version: a prospective cohort study

BackgroundTo investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV) in breech presentation.MethodsProspective cohort study in 141 women (≥ 35 weeks gestation) with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV. Main outcome measure was the relation between maternal thyroid function and ECV outcome indicated by post ECV ultrasound.ResultsECV success rate was 77/141 (55%), 41/48 (85%) in multipara and 36/93 (39%) in primipara. Women with a failed ECV attempt had significantly higher TSH concentrations than women with a successful ECV (p < 0.001). Multiple logistic regression showed that TSH (OR: 0.52, 95% CI: 0.30-0.90), nulliparity (OR: 0.11, 95% CI: 0.03-0.36), frank breech (OR: 0.30, 95% CI: 0.10-0.93) and placenta anterior (OR: 0.31, 95% CI: 0.11-0.85) were independently related to ECV success.ConclusionsHigher TSH levels increase the risk of ECV failure.Trial registration numberClinicalTrials.gov: NCT00516555

Prediction of Success of External Cephalic Version after 36 Weeks

We aimed to develop a predictive model for the chance of a successful external cephalic version (ECV). We performed a prospective cohort study of women with a singleton fetus in breech presentation with a gestational age of 36 weeks or more. Data on parity, maternal age, body mass index, ethnicity, gestational age, placental location, fetal position, estimated fetal weight, and amniotic fluid were recorded in all participants. Multivariable logistic regression analysis with a stepwise backward selection procedure was used to construct a prediction model for the occurrence of successful ECV. We included a total of 310 women. Multivariable logistic regression analysis demonstrated that multiparity, increasing estimated fetal weight, and normal amniotic fluid were favorable predictors of successful ECV. Anterior placenta location was an unfavorable predictor for ECV outcome. Discrimination of the model was fair (area under the curve 0.71), and the calibration of the model was acceptable. Our prediction model appears to discriminate between women with a poor chance of successful ECV (less than 20%) and women with a good chance of success (more than 60%). When this model is validated externally, it could be used for patient counseling and clinical decision making.

Outcome of External Cephalic Version in Terms of Success Rate and Fetomaternal Complications

Objective: To assess the outcome of external cephalic version for management of breech fetuses at term in terms of: · Success rate of ECV. · Feto maternal complications. Design: Prospective interventional study. Setting: Department of Obstetrics and Gynaecology, Unit-III, Services Hospital, a tertiary care centre in Lahore, Pakistan. Patients: From July 19, 2007 to January 14, 2009, the study was conducted involving pregnant women with breech presentation between 37 - 41 weeks. An external cephalic version was carried out. Data was collected for identifying the success or failure of external cephalic version and feto maternal complications. Main Outcome Measures: Maternal and fetal outcome measures assessed in terms of: · Success rate of external cephalic version. · Maternal and fetal complications. Statistical Data Analysis: Collected Data was entered into SPSS (Statistical Package for Social Sciences) version 12.0 and analyzed descriptively. Mean and SD was calculated for quantitation variable like gestational age and percentages were calculated for qualitative variables like gravida, complication etc. Results: Forty women were included in the study. External cephalic version was successful in 60% patients. The majority (70.83%) of this group achieved the vaginal delivery. The rate of caesarean section was 29.16%. The most common indication for caesarean section was fetal distress and failure to progress. There was no foetal or maternal adverse outcome except one in which membranes ruptured during the procedure. The majority of women were satisfied with external cephalic version. Conclusion: External cephalic version has good success rate. External cephalic version is relatively safe, simple to learn and perform. Well equipped Obstetrics Units should routinely offer the procedure in selective cases. ECV helps to avoid a signi-ficant number of caesarean sections. Properly counseled women are satisfied with the procedure. Keywords: External Cephalic Version. Breech Presentation. Success Rate. Fetomaternal Complications.

P250 Score to predict the outcome of external cephalic version

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S484-S484 Poster presentations P250 Score to predict the outcome of external cephalic version J. Burgos, Search for more papers by this authorP. Cobos, Search for more papers by this authorB. Otero, Search for more papers by this authorL. Fernández-Llebrez, Search for more papers by this authorJ. Pijoán, Search for more papers by this authorJ. Melchor, Search for more papers by this author J. Burgos, Search for more papers by this authorP. Cobos, Search for more papers by this authorB. Otero, Search for more papers by this authorL. Fernández-Llebrez, Search for more papers by this authorJ. Pijoán, Search for more papers by this authorJ. Melchor, Search for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61740-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S484-S484 RelatedInformation

Does fetal weight estimated by ultrasound really affect the success rate of external cephalic version?

OBJECTIVE. To determine whether fetal weight estimated by ultrasound on the day the external cephalic version (ECV) is related to the procedure's success rate. DESIGN. Retrospective cohort study. Setting. University hospital. POPULATION OR SAMPLE. Two hundred women with a singleton pregnancy undergoing an ECV attempt between March 2002 and March 2006. METHOD. Projected birthweight at delivery was calculated. Logistic regression analysis, by grams and by weight intervals, and multiple correspondence analysis were performed to determine whether or not the weight was related to the procedure's success. Specific statistical analysis was undertaken to minimize measurement bias in fetal weight estimation. MAIN OUTCOME MEASURE. Success of ECV in relation to estimated fetal weight. RESULTS. Measurement bias was ruled out because no statistically significant differences were identified with the Student's t-test (p>0.05), Bland-Altman's agreement analysis, and the interclass correlation coefficient analysis (ICC = 0.829; CI95% 0.772-0.871; p<0.01). By logistic regression analysis, a variable relation between fetal weight estimated by ultrasound and ECV success was detected, while multiple correspondence analysis suggested that variations in fetal weight are weakly related to the procedure's success or failure. No relation was identified between ECV and birthweight (p = 0.38) when the delivery took place in the same week as the version. CONCLUSIONS. Estimated fetal weight before ECV seems not to be related to the outcome of ECV.

Ultrasound factors to predict the outcome of external cephalic version: a meta‐analysis

To systematically review the medical literature reporting on ultrasound factors that can be predictive for the outcome of an attempt at external cephalic version (ECV). MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched. Studies reporting on potential ultrasound prognosticators and ECV success rates that allowed construction of a 2x2 table were selected. We selected 37 primary articles reporting on 7709 women. Posterior placental location (odds ratio (OR), 1.9; 95% CI, 1.5-2.4), complete breech position (OR, 2.3; 95% CI, 1.9-2.8) and an amniotic fluid index>10 (OR, 1.8; 95% CI, 1.5-2.1) were predictors of successful ECV. Success of an ECV attempt is associated with ultrasound parameters such as fetal position, amniotic fluid and placental location. This knowledge can be used to develop a prognostic model to predict successful ECV.

Safety and efficacy of external cephalic version for women with a previous cesarean delivery

Objective To evaluate the success and morbidity rates for attempted external cephalic version (ECV) in patients with one previous cesarean delivery (CD) and a breech-presenting fetus at term. Study design This is a retrospective study of outcomes of ECV at our institution for all women with one previous CD and a breech-presenting fetus at term between January 1997 and June 2005. A literature review was also performed as a Medline search (1966–2006). Results ECV was attempted for 42 women with a breech-presenting fetus and previous CD. The success rate of ECV was 74.0%, and 84% of women with successful ECV delivered vaginally. All fetal and maternal outcomes were favorable. Only four Medline reports met our inclusion criteria, representing a total of 124 patients and a mean ECV success rate of 76.6%. Thus we assessed 166 cases of attempted ECV and find an average ECV success rate of 76.5% and favorable fetal and maternal outcomes. Conclusions Women with a breech-presenting fetus at term and previous CD, who desire a trial of labor, should be counseled regarding the accumulating evidence about the efficacy and apparently safety of this procedure and may be offered an ECV attempt.

External cephalic version among women with a previous cesarean delivery: report on 36 cases and review of the literature

Whether or not women with a previous cesarean section should be considered for an external cephalic version remains unclear. In our study, we sought to examine the relationship between a history of previous cesarean section and outcomes of external cephalic version for pregnancies at 36 completed weeks of gestation or more. Data on obstetrical history and on external cephalic version outcomes was obtained from the C.H.U. Sainte-Justine External Cephalic Version Database. Baseline clinical characteristics were compared among women with and without a history of previous cesarean section. We used logistic regression analysis to evaluate the effect of previous cesarean section on success of external cephalic version while adjusting for parity, maternal body mass index, gestational age, estimated fetal weight, and amniotic fluid index. Over a 15-year period, 1425 external cephalic versions were attempted of which 36 (2.5%) were performed on women with a previous cesarean section. Although women with a history of previous cesarean section were more likely to be older and para >2 (38.93% vs. 15.0%), there were no difference in gestational age, estimated fetal weight, and amniotic fluid index. Women with a prior cesarean section had a success rate similar to women without [50.0% vs. 51.6%, adjusted OR: 1.31 (0.48-3.59)]. Women with a previous cesarean section who undergo an external cephalic version have similar success rates than do women without. Concern about procedural success in women with a previous cesarean section is unwarranted and should not deter attempting an external cephalic version.

Nifedipine as a Uterine Relaxant for External Cephalic Version

To estimate the effectiveness of nifedipine as a uterine relaxant during external cephalic version to correct breech presentation. In this randomized, double-blind, placebo-controlled trial, women with a singleton fetus in breech presentation and a gestational age of 36 weeks or more were eligible for enrollment. Participating women received two doses of either nifedipine 10 mg or placebo, 30 and 15 minutes before the external cephalic version attempt. The primary outcome was a cephalic-presenting fetus immediately after the procedure. Secondary outcome measures were cephalic presentation at delivery, mode of delivery, and adverse events. A sample size of 292 was calculated to provide 80% power to detect a 17% improvement of the external cephalic version success rate, assuming a placebo group rate of 40% and alpha of .05. Outcome data for 310 of 320 randomly assigned participants revealed no significant difference in external cephalic version success rates between treatment (42%) and control group (37%) (relative risk 1.1, 95%; 95% confidence interval 0.85-1.5). The cesarean delivery rate was 51% in the treatment group and 46% in the control group (relative risk 1.1, 95% confidence interval 0.88-1.4). Nifedipine did not significantly improve the success of external cephalic version. Future use of nifedipine to improve the outcome of external cephalic version should be limited to large clinical trials.

Clinical factors to predict the outcome of external cephalic version: a metaanalysis

The objective of the study was to systematically review the medical literature reporting on potential clinical prognosticators for the outcome of external cephalic version (ECV). Medline, EMBASE, and Cochrane Central Register of Controlled Trials were searched. Studies reporting on potential clinical prognosticators and ECV success rates that allowed construction of a 2 x 2 table were selected. We detected 53 primary articles reporting on 10,149 women. Multiparity (P >/= 1.00; odds ratio [OR], 2.5; 95% confidence interval [CI], 2.3-2.8), nonengagement of the breech (OR, 9.4; 95% CI, 6.3-14), a relaxed uterus (OR, 18; 95% CI, 12-29), a palpable fetal head (OR, 6.3; 95% CI, 4.3-9.2), and maternal weight less than 65 kg (OR, 1.8; 95% CI, 1.2-2.6) were predictors for successful external cephalic version. Success of an ECV attempt is associated with clinical factors. This should be taken into account in the counseling of women prior to an ECV attempt.

247: External cephalic version among women with a previous cesarean section: A report on 31 cases

Whether or not women with a previous cesarean section should be considered for an external cephalic version remains unclear. In our study, we sought to examine the relationship between a history of previous cesarean section and outcomes of external cephalic version for pregnancies above 36 weeks of gestation.

Impact of parity on obstetric and neonatal outcome of external cephalic version

SummaryThis study sought to investigate the impact of parity on the outcome of external cephalic version (ECV) over a 3-year period. In the study, 163 women with singleton uncomplicated breech pregnancy at term were offered ECV and 103 (63%) underwent the procedure. In 42 women, ECV was successful and 74% had a vaginal vertex delivery; whereas 61 women had a failed ECV and none had a vaginal vertex delivery. The probability of vaginal vertex delivery after ECV increased five-fold in nulliparous women (OR 5.2, 95% CI 1 – 42.8) and four-fold (OR 3.8, 95% CI 1.3 – 11.5) in multiparous women. After successful ECV, 50% of nulliparous women and 88.5% of multiparous women had a vaginal vertex delivery (p = 0.006). Neonatal outcome was favourable in all patients. We conclude that parity has little impact on efficacy of ECV, but significantly influences the overall chance of vaginal vertex delivery in women with an uncomplicated breech presentation at term.

Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997–2004

Probabilistic information on outcomes of breech presentation is important for clinical decision-making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997-2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy-one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset-of-labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation.

Outcome of External Cephalic Version Complicated by a Nuchal Cord

Outcome of External Cephalic Version Complicated by a Nuchal Cord

Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term

The aim of this study was to determine the frequency of adverse maternal and fetal outcomes of both external cephalic version (ECV) and persisting breech presentation at term. We conducted a systematic review of the literature using Medline, Embase and All Evidence Based Medicine (EBM) Reviews databases. Data were extracted from studies that compared women who had an ECV from 36 weeks' gestation with a similar control group of women enrolled at the same gestational age, eligible for, but who did not have an ECV. Eleven studies with a total of 2503 women were included. Adverse outcomes related to ECV were rarely reported and in most studies there was no evidence that relevant outcomes were ascertained among similar women who did not have an ECV. There was no increased risk of antepartum fetal death associated with ECV, but numbers were small. There were no reported cases of uterine rupture, placental abruption, prelabour rupture of membranes or cord prolapse, but these outcomes were not examined among controls. Onset of labour within 24 h and nuchal cord was non-significantly higher among women who had an ECV compared with those with a persisting breech. Despite limited reporting and small numbers, the results of our review suggest that adverse maternal and fetal outcomes of both ECV and persisting breech presentation are rare. Only with improved reporting and collection of safety data on ECV and persisting breech presentation can we provide high-quality information to assist informed decision making by pregnant women with a breech presentation at term.

Breech presentation: An audit project as means of pursuing clinical excellence

SummaryClinical audit is an effective quality improvement process to evaluate important clinical issues. Breech presentation is such an issue due to its contribution to the rising caesarean section (CS) rate. We set out to assess the management of breech presentation using, as standards, the delivery suite protocol and national guidelines. Our first audit revealed a low success rate of external cephalic version (ECV) and deficient documentation of written consent for ECV, other aspects of care being satisfactory. The results were presented to a multidisciplinary meeting and disseminated to relevant stakeholders. A re-audit was then performed. It confirmed significant improvement in the documentation of consent for ECV. It also revealed a good detection rate of breech, optimal offer rate of ECV and good neonatal outcome. However, uptake of ECV as well as the success rate could both be improved so as to reduce the CS rate for breech presentation. We discuss options for improving the uptake and success rate for ECV.

Outcome of external cephalic version after 36 weeks' gestation without tocolysis

Outcome of external cephalic version after 36 weeks' gestation without tocolysis

Outcome of external cephalic version after 36 weeks' gestation without tocolysis.

Despite its efficacy, external cephalic version (ECV) at term is not universally employed. Published series of Caucasian women are small and concerns regarding safety and spontaneous version remain. We review the outcomes of 26 months of a breech clinic in a Dublin teaching hospital. All women with known breech presentation at 36+ weeks were referred unless another indication for cesarean section existed. Unstable lie, fetal compromise, antepartum hemorrhage, and patient refusal were the only contraindications to ECV. One operator attempted all versions, without tocolysis. Three hundred seventy women were referred and in 356 (95%), version was attempted at a mean gestation of 37 + 3 weeks; 195 (55%) were nulliparous and 161 (45%) were multiparous. The success rate was 43%, including 33% of nulliparous and 54% of multiparous women. There were three perinatal deaths (0.8%), all unrelated to the version. Minor complications were rare, although two women were delivered by cesarean section shortly after unsuccessful version. Ninety-three percent of successful versions were cephalic at delivery, as were 4% of unsuccessful versions; 12% of infants with a cephalic presentation after successful version were delivered by cesarean section. From this large series, ECV is extremely safe. Spontaneous version after unsuccessful ECV and reversion after successful ECV are unusual.

Outcome of External Cephalic Version After 36 Weeks' Gestation Without Tocolysis

Objective: Despite its efficacy, external cephalic version (ECV) at term is not universally employed. Published series of Caucasian women are small and concerns regarding safety and spontaneous version remain. We review the outcomes of 26 months of a breech clinic in a Dublin teaching hospital.Methods: All women with known breech presentation at 36+ weeks were referred unless another indication for cesarean section existed. Unstable lie, fetal compromise, antepartum hemorrhage, and patient refusal were the only contraindications to ECV. One operator attempted all versions, without tocolysis.Results: Three hundred seventy women were referred and in 356 (95%), version was attempted at a mean gestation of 37 + 3 weeks; 195 (55%) were nulliparous and 161 (45%) were multiparous. The success rate was 43%, including 33% of nulliparous and 54% of multiparous women. There were three perinatal deaths (0.8%), all unrelated to the version. Minor complications were rare, although two women were delivered by cesarean section shortly after unsuccessful version. Ninety-three percent of successful versions were cephalic at delivery, as were 4% of unsuccessful versions; 12% of infants with a cephalic presentation after successful version were delivered by cesarean section.Conclusions: From this large series, ECV is extremely safe. Spontaneous version after unsuccessful ECV and reversion after successful ECV are unusual.

Predictors of Successful External Cephalic Version at Term

Objective To investigate clinical and ultrasonographic predictors of outcome of external cephalic version at term. Design Prospective observational study. Setting University obstetric unit. Population All external cephalic versions performed over two years (n = 243). Methods Nineteen different clinical and ultrasonographic variables were recorded before each procedure. The ability of each of the 19 variables to predict the success or failure of external cephalic version was assessed by univariate analysis. The study population was then divided into two subgroups of 129 and 114 patients by random allocation using computer generated numbers. Logistic regression was performed in each subgroup to assess the relative importance and independence of the important variables. The derived regression models were then applied to the other subgroup of patients to assess accuracy and reproducibility. Results The overall success rate of the procedure was 69.5%. Both regression models identified the same three variables as independent predictors of failed versions: 1. presenting part engaged; 2. difficult to palpate the fetal head, and 3. a tense uterus on palpation. The two models correctly predicted 75.2% and 84.2% of outcomes in the other subgroup. If uterine tone, which was assessed after administration of tocolytic, was excluded from the analysis, the other two factors remained in the models, with the addition of nulliparity as a significant predictor of failed external cephalic version. The chance of success of external cephalic version in the original 243 women was found to be < 20% if two of these variables were present, 0% if all three were present, and 94% if none were present. Conclusions The outcome of external cephalic version can be predicted by easily available clinical parameters.