Singleton Breech Research Articles

Neonatal outcomes of planned vaginal delivery versus planned cesarean section for breech presentation at term: Population-based study on 546,842 breech births across the United States between 2008 and 2017

IntroductionOver the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses. MethodsThis retrospective population-based cohort study utilized data from the United States’ Period Linked Birth-Infant Death Public Use Files from 2008 to 2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n = 546,842) and divided into two cohorts: women who had a planned vaginal birth (n = 116,828), and women who had a planned cesarean section (n = 430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes. ResultsIt was observed that 26.14 % of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95 % CI 1.16–1.52, admission to NICU,1.23, 1.19–1.27, ventilation support at 〈 6 h of life, 1.47, 1.42–1.52, ventilation support at 〉 6 h of life, 1.19, 1.08–1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06–2.50. ConclusionIn women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.

Maternal outcomes of planned mode of delivery for term breech in nulliparous women.

To estimate short- and long-term maternal complications in relation to planned mode of term breech delivery in first pregnancy. Register-based cohort study. Denmark. Nulliparous women with singleton breech delivery at term between 1991 and 2018 (n = 30,778). We used data from the Danish national health registries to identify nulliparous women with singleton breech presentation at term and their subsequent pregnancies. We performed logistic regression to compare the risks of maternal complications by planned mode of delivery. All data were proceeded and statistical analyses were performed in SAS 9.4 (SAS Institute Inc. Cary, NC, USA). Postpartum hemorrhage, operative complications, puerperal infections in first pregnancy and uterine rupture, placenta previa, post-partum hemorrhage, hysterectomy and stillbirth in the subsequent two pregnancies. We identified 19,187 with planned cesarean and 9,681 with planned vaginal breech delivery of which 2,970 (30.7%) delivered vaginally. Planned cesarean significantly reduced the risk of postoperative infections (2.4% vs 3.9% adjusted odds ratio (aOR): 0.54 95% confidence interval (CI) 0.44-0.66) and surgical organ lesions (0.06% vs 0.1%; (aOR): 0.29 95% CI 0.11-0.76) compared to planned vaginal breech delivery. Planned cesarean delivery in the first pregnancy was associated with a significantly higher risk of uterine rupture in the subsequent pregnancies but not with risk of postpartum hemorrhage, placenta previa, hysterectomy, or stillbirth. Compared to planned vaginal breech delivery at term, nulliparous women with planned cesarean breech delivery have a significantly reduced risk of postoperative complications but a higher risk of uterine rupture in their subsequent pregnancies.

Confronting the Fear: Our Experience with Breech Vaginal Delivery-A Retrospective Analysis

Introduction: Mode of delivery for term singleton breech presentation has been a raging topic of discussion for decades and continues to be so. The ‘Term Breech Trial’ was a big blow to vaginal breech delivery leading to a torrential increase in the rate of caesarean sections the world over. We intend to compare and evaluate the maternal and perinatal outcomes of vaginal versus caesarean section breech delivery so as to analyse the safety of vaginal delivery for breech presentation. Objectives: Analyse and compare perinatal and maternal outcomes between vaginal versus caesarean deliveries of term or near-term singleton breech presentation. Materials and Methods: Retrospective comparison between 30 vaginal breech deliveries (Group 1) and 252 caesarean deliveries (Group 2) done for singleton breech presentation between 36 weeks to 42 weeks, either in early or advanced labour conducted between January 2015-January 2022 at various Military Hospitals. Statistical Analysis: The association between maternal and perinatal outcomes was estimated using the Chi-square test and Fisher exact test with P < 0.05 considered statistically significant. Results: No maternal complications were noted in Group 1 while in Group 2 surgical site infection and post-partum haemorrhage of varying degree, was noted in 14% cases and 7% cases respectively which was statistically significant. There was no significant difference noted between the groups with regard to neonatal outcomes or NICU admission. Conclusion: Vaginal delivery for termsingleton breech is a reasonable option in well-selected patients at optimally equipped centres, in the hands of an experienced Obstetrician.

The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis

IntroductionEpidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there’s little evidence and recommends further evaluation.ObjectiveThe aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia.DesignThis study was a retrospective cohort study.SampleThis study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018.MethodsNeonatal and maternal outcome was analyzed and compared between women receiving “walking” epidural anesthesia and women without an epidural anesthesia.ResultsFetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)".ConclusionEpidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.

Effect of the Presence of Nuchal Cords on Vaginal Breech Labor.

Breech delivery has been reported to be associated with a high incidence of abnormal fetal heart rate pattern leading to neonatal asphyxia. In this study, we examined the effect of the presence of nuchal cords on perinatal outcomes of vaginal breech labor. We reviewed the obstetric records of all singleton breech labor cases at the Japanese Red Cross Katsushika Maternity Hospital between 1999 and 2011. Of the 266 breech labor cases in singleton pregnancies, the presence of nuchal cords was recognized in 50 cases (18.8%) on neonatal findings at birth. We compared the clinical characteristics and perinatal outcomes between the breech labor cases with and without nuchal cords. A chi-square test was used for categorical data, and a p-value <0.05 was considered significant. It was found that the incidence of fetal heart rate abnormality during breech labor or neonatal asphyxia in the deliveries with nuchal cords was not significantly different from that in those without nuchal cords. Also,there was no significant difference in the rate of emergent caesarean delivery between the two labors with and without nuchal cords. The current results suggest that the presence of nuchal cords may not be associated withperinatal outcomes. Our results may become one of several pieces of evidence leading to the alleviation of anxiety in pregnant women with breech presentation and fetal nuchal cords.

Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries.

Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor analgesia (epidural analgesia (EA) vs. remifentanil patient-controlled analgesia (PCA)) and intrapartum cesarean sections (CS), and maternal and neonatal adverse outcomes in breech and twin vaginal births. A retrospective analysis of planned vaginal breech and twin deliveries at the Department of Perinatology, University Medical Centre Ljubljana, was performed for the period 2013-2021, using data obtained from the Slovenian National Perinatal Information System. The pre-specified outcomes studied were the rates of CS in labor, postpartum hemorrhage, obstetric anal sphincter injury (OASI), an Apgar score of <7 at 5 min after birth, birth asphyxia, and neonatal intensive care admission. A total of 371 deliveries were analyzed, including 127 term breech and 244 twin births. There were no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups in any of the outcomes studied. Our findings suggest that both EA and remifentanil-PCA are safe and comparable in terms of labor outcomes in singleton breech and twin deliveries.

Cephalic version by moxibustion for breech presentation.

Cephalic version by moxibustion for breech presentation.

Impact of full vs empty urinary bladder on external cephalic version success: a randomized controlled trial

External cephalic version is a procedure used to turn a fetus from a breech position to a cephalic position before delivery. The success rate of the external cephalic version can be affected by various factors; however, the effect of bladder volume on the success rate of the external cephalic version remains controversial. This study aimed to determine the effect of urinary bladder status (full or empty) on the success rate of the external cephalic version through a prospective randomized study. This was a prospective randomized controlled trial conducted at a tertiary care obstetrical center. Overall, 70 women with a singleton breech presentation at term undergoing external cephalic version were randomly allocated into 2 groups: external cephalic version with an empty bladder and external cephalic version with a full bladder. The external cephalic version procedure was performed by experienced obstetricians under ultrasound guidance. The primary outcome was the success rate of the external cephalic version. The success rate of the external cephalic version was 67.56% (25/37) in the full bladder group and 54.54% (18/33) in the empty bladder group, with no statistically significant difference between the groups (P=.26). In addition, the relative risk of successful external cephalic version was 1.23 (95% confidence interval, 0.84-1.81), indicating no significant difference. This randomized controlled trial demonstrated that the presence of a full or empty urinary bladder does not significantly affect the success rate of the external cephalic version in women with singleton breech presentation at term. Our findings suggest that women undergoing an external cephalic version do not need to have a full bladder to improve the success rate of the procedure.

Challenges in prenatal diagnosis of foetal anorectal malformation and hydrocolpos – Case report

and importance: Foetal hydrocolpos and anorectal malformation are difficult to diagnose prenatally due to abundance of differential diagnoses. This case report presents the challenges of diagnosing such disorders. A G3P2A0 woman came at 32 weeks of pregnancy with a referral for foetal ovarian cyst. Ultrasound revealed a singleton breech pregnancy, estimated foetal weight 3528g. A septate abdominal cyst measuring 11.31×7.17 cm and polyhydramnios were present. Elective caesarean section delivered a female baby weighing 2820g and measuring 43 cm. Neonatal examination revealed a right lateral suprapubic mass and a rectovestibular fistula. A sinoscopy revealed a suspected hydrocolpos. An abdominal hydrocolpos drainage was performed; a patent urachus and normal bilateral adnexa were present. Hydrocolpos is a rare congenital disorder due to distal obstruction of various etiologies. It may be mistaken with other pathologies, including fetal ovarian cysts. A genitourinary congenital abnormality may occur in conjunction with other abnormalities, including gastrointestinal tract anomalies. The presence of imperforate anus and/or fistula should alert the clinician of a possible association with VACTERL syndrome. Hydrocolpos is a rare congenital genitourinary disorder with various differential diagnoses. Simultaneous presence of other abnormalities is likely, with possible association to other syndromes.

Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long-term pediatric respiratory hospitalization of the offspring.

To compare the long-term respiratory morbidity of offspring born by cesarean delivery for breech presentation with that of those delivered vaginally. A population-based cohort analysis including all singleton breech deliveries between the years 1991 and 2014, comparing long-term respiratory morbidity of offspring born in breech presentation, according to mode of delivery. Offspring with congenital malformations, perinatal deaths, and instrumental deliveries were excluded. Respiratory morbidity included hospitalizations (up to age 18 years), as recorded in hospital records. A Kaplan-Meier survival curve compared cumulative respiratory morbidity. A Weibull parametric survival model controlled for confounders and repeat deliveries. A total of 7337 breech deliveries were included; 6376 (86.9%) cesarean deliveries and 961 (13.1%) vaginal breech deliveries. The Kaplan-Meier survival curve demonstrated higher cumulative incidence of respiratory morbidity in the cesarean delivery group compared with vaginal delivery (log rank test P= 0.006). Using a Weibull parametric survival model to control for confounders, cesarean delivery was found to be an independent risk factor for long-term respiratory morbidity of the offspring (adjusted hazard ratio 1.87, 95% confidence interval 1.32-2.65, P< 0.001). Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long-term pediatric respiratory morbidity of the offspring.

An e-Delphi study on mode of delivery and extremely preterm breech singletons.

To understand clinicians' consensus on mode of delivery in extremely preterm breech infants; assess knowledge on neonatal outcomes and its impact on consensus. A two-round Delphi of obstetrical or neonatal care providers, recruited from national conferences and investigator networks. Round one assessed decision-making (vignettes), and knowledge; the second round reassessed vignettes after presenting outcome data. In round one (102 respondents), consensus (a priori, ≥75% agreement) was achieved in 4/13 vignettes: two when likely/very likely to offer Cesarean (26 and 27 weeks) and two for unlikely/very unlikely (23 weeks growth restriction, ± adverse features). Clinicians generally underestimated neonatal outcomes. In round two (87 respondents), three scenarios achieved consensus (likely/very likely to offer Cesarean at 25-27 weeks); in five other vignettes, not offering Cesarean was reduced in ≥15% of respondents. Limited consensus exists on extremely preterm breech mode of delivery, partly associated with neonatal outcome underestimation. The authors follow the World Health Organization's notation on gestational age. Under this notation, the first day of the last menstrual period (LMP) is day 0 of week 0. Therefore, days 0-6 represent completed week 0, days 7-13 represent completed week 1 and so on.

207 Vaginal breech: a delivery in looming extinction?

Introduction: A planned vaginal delivery should be an option in selected women with a term singleton breech fetus and in those with a cephalic first twin. Patient selection criteria, as well as provider experience are probably the two pillars for a successful delivery. Adequately training the younger generations of obstetricians is mandatory. Methods: A retrospective 8.5-year hospital cohort with review of singleton and twin vaginal breech deliveries retrieving maternal and fetal features and neonatal outcome.

Audit of Singleton Breech Delivery in a Tertiary Hospital

Background: The 2000 Term Breech Trial (TBT) demonstrated that planned caesarean section was safer for the 3-4% of pregnancies in which the fetus will be in the breech presentation at term. However, the approach to delivery has been a topic of interesting debate and heated controversy among obstetricians. Objectives: The aim of this study was to find out the incidence and perinatal outcome of singleton breech delivery at the University of Abuja Teaching Hospital, Abuja, and North-Central Nigeria. Methodology: This was a retrospective study of singleton breech deliveries managed at the University of Abuja Teaching Hospital between 1st January 2015 to 31st December 2019. Data on social-demographic characteristics, presentation, mode of delivery and neonatal outcome were obtained from the case notes retrieved from the Medical health information Department. Result: There were 287 singleton breech deliveries out of 10416 deliveries during the study period given an incidence rate of 2.8%. Majority of the women 265 (92%) were between 21-40 years with a mean age of 30.27 +/-5.66 years. There were 144 (50.2%) unbooked patients. Majority of the women 188 (65.5%) were multipara. About 108 (37.6%) of the babies were delivered as preterm. Assisted breech deliveries was conducted in 162 (56.44%) while 125 (43.55%) were via caesarean section with a caesarean section rate of 43.55%. The commonest indication for caesarean section was Breech plus previous uterine scar in 36 (28.8%). About 28 (9.8%) babies were born with low APGAR scores and had severe birth asphyxia. Majority of the babies, 23 (8.1%) delivered through assisted breech delivery suffered severe birth asphyxia compared to 3 (1.0%) babies who were delivered via caesarean section. Significant association was noted between route of delivery and perinatal outcome. Again, 77 (27.8) primigravidae had breech delivery in this study. About 9 (3.1%) babies delivered to these primigravidae had poor APGAR scores and suffered severe birth asphyxia. However, 8 (2.8%) babies were delivered through assisted vaginal delivery compared to 1 (0.3%) baby who was delivered through caesarean section. The test showed a significant association in perinatal outcome in primigravidae who were allowed to have assisted breech delivery with Chi-Square value of 50.551, df =2 and p-value of 0.0002 which is less than the significant level of 0.05. There were 41 perinatal deaths given a perinatal mortality rate of 143/1000. It was noted that 10 (3.5%) babies had intrauterine fetal death before delivery, while 31 (10.8%) occurred as fresh stillbirth and early neonatal death. About 26 (9.1%) of the perinatal were through assisted breech delivery and 5 (1.7%) were through caesarean section. The mean birth weight was 2.6 +/- 0.92 years. Maternal morbidities were associated with mothers who had caesarean section, this however was not significant. Conclusion: Breech delivery was common and was associated with high perinatal morbidity and mortality. Route of delivery has significant association with perinatal outcome. Careful case selection and skillful delivery protocol would ensure optimal perinatal outcome that will in turn reduce caesarean section rate and reduce the morbidities associated with caesarean section.

Benefits of the «en caul» technique for extremely preterm breech vaginal delivery

IntroductionThe “en caul” technique, i.e. delivery with intact membranes, may reduce the risk of obstetric trauma in vaginal breech delivery of extreme preterm infants. We aimed at comparing perinatal mortality and morbidity among extremely preterm breech vaginal deliveries between infants delivered “en caul” and those with “ruptured membranes”. Material and methodsWe performed a fourteen-year retrospective study in a tertiary university center. All vaginal deliveries of singleton breech live infants with an antenatal decision of active resuscitation between 24 weeks and 27+6 weeks were included. Perinatal outcomes were compared between the “en caul” group, with intact membranes at the onset of pushing efforts and the “ruptured membranes” group, with ruptured membranes at the onset of pushing efforts. The primary outcome was perinatal mortality defined by intrapartum or neonatal death. The secondary outcomes were fetal extraction difficulties, arterial pH and 5 min Apgar score. ResultsWe included 52 infants in the “en caul” group and 71 in the “ruptured membranes” group. The perinatal mortality rate did not differ between the two groups (19.2% in the “en caul” group versus 28.2% in the “ruptured membranes” group, p = 0.25). The mean arterial pH at birth was higher in the « en caul » group (7.32 ± 0.1 vs 7.24 ± 0.1, p = 0.001). There were no differences between the groups for fetal extraction difficulties, especially fetal head entrapment (9.6% versus 9.9%). ConclusionEven though the “en caul” technique does not seem to decrease the perinatal mortality rate, it remains a simple technique, which could improve neonatal morbidity.

PERINATAL OUTCOMES OF SINGLETON BREECH DELIVERIES IN A TERTIARY CARE CENTRE IN NEPAL

Background: Breech presentation has been associated with higher rates of perinatal morbidity irrespective of mode of delivery. The aim of this study was to determine the prevalence and perinatal outcomes of singleton breech deliveries at Chitwan Medical College, a tertiary level hospital in Nepal. Methods: A retrospective review of records of all women who delivered at Chitwan Medical College with breech presentation from September 2018 to October 2020 was conducted. Information on demographic variables, obstetric characteristics and perinatal outcomes were obtained, recorded and analyzed. Results: Out of 6712 cases of deliveries during the study period, 226 had breech presentation with prevalence of 3.37%. One hundred ninety-one (84.5%) of them had undergone Caesarean delivery with 125 (65.4%) emergency and 66 (34.6%) elective Caesarean delivery. More than two third (70.4%) of breech deliveries were term deliveries while 28.8% were preterm. There were 2 cases of still births and 1 neonatal death with Perinatal Mortality Rate of 13.27 per 1000 breech deliveries. Vaginal breech delivery was associated with higher perinatal mortality, low Apgar score and low birth weight. Caesarean breech delivery was associated with increased rates of Neonatal Intensive Care Unit admission. Conclusions: The neonatal mortality and morbidity were higher with the vaginal breech deliveries. However further studies with larger sample size and greater statistical power is necessary to draw definitive conclusion.

To determine the rate of success of external cephalic version in low risk breech presentations and possible factors affecting its success in POF hospital, Wah Cantt.

Abstract&#x0D; &#x0D; Background&#x0D; The caesarean section rate is on the rise for various reasons. One of the reason is breech presentation . External cephalic version is a procedure to manipulate the baby from breech to cephalic presentation externally through the maternal abdomen under USG guidance . Success in ECV decreases the breech presentation and hence caesarean section rate .&#x0D; Methods&#x0D; This retrospective study was conducted by Wah Medical College in POF hospital from10 Oct 2015- 10 Oct 2019 after approval from the ethical committee .&#x0D; It included 56 low risk singleton breech presentations from 36 wks- 40 wks after taking their informed consent While those with &lt; than 36 wks (primis) and &gt;40 wks gestation, refusal to ECV , with absolute contraindication to ECV&amp; with medical and obstetric complications (ie scarred uterus, liquor &lt;than 8 cm &amp; &gt; than 17 cm, fetal growth restriction, preclampsia, gestational diabetes &amp; abnormal cardiotocography) were excluded from the study. ECV was performed by single obstetrician in labour room with facilities of cardiotocograph and emergency caesarean section. Cardiotocography of the fetus for 30-40 min was done just before &amp; after the procedure of ECV. ECV was declared successful on cofirming head of the fetus occupying the lower uterine segment on ultrasound. .Number of successful ECVs &amp; specific factors of the women &amp; the baby (age . parity, amniotic fluid index ,type of breech, engagement of breech, position of back of baby) were chosen to observe their effect on success of ECV.&#x0D; Results&#x0D; External cephalic version was successful in 27 (48.2%) &amp; unsuccessful in 29 (51.8%)of women .Multiparity , unengaged breech &amp; type of breech (complete flexed) ( with p values .001, .000 &amp; .001 respectively) had statistically significant positive association with successful external cephalic version.&#x0D; Conclusion&#x0D; ECV should be offered to all women with low risk breech presentations. Knowledge of factors predictive of ECV success can be utilized in selecting cases for ECV &amp;counselling the women regarding the success and failure of ECV.&#x0D; &#x0D;

Safety and efficacy of external cephalic version after a previous caesarean delivery: A systematic review.

External cephalic version (ECV) is a common procedure and has been shown to be safe and effective in turning a baby from a breech to cephalic presentation. However, whether ECV is safe and effective in women with a scarred uterus from a previous caesarean section remains contentious. To evaluate the safety and efficacy of external cephalic version in women with a singleton breech pregnancy and at least one previous caesarean delivery. Literature searches were conducted on MEDLINE, PUBMED, EMBASE, CINAHL and SCOPUS up to June 2020. The search strategy included the following keywords: ('external cephalic version OR ECV') AND ('previous OR prior OR past' AND 'caesarean OR caesarean OR uterine scar'). Studies were included if they evaluated the efficacy and/or safety of external cephalic version in women after 36 weeks' gestation with a singleton breech pregnancy and at least one previous caesarean delivery. Nine studies were included in the review. ECV success rates and subsequent vaginal delivery rates ranged from 50 to 100% and from 50 to 74.9%, respectively. ECV complications reported included abnormal fetal heart rate, abnormal cardiotocography and transient vaginal bleeding. No studies reported cases of uterine rupture. ECV in women with a previous caesarean delivery is a relatively successful and low-risk procedure compared to women without a previous caesarean delivery. The results from this systematic review provide useful information for professional bodies in updating clinical guidelines such that ECV may be offered to women with one previous caesarean delivery.

Smoke or smokeless moxibustion treatment for breech presentation: A three-arm pilot trial.

AimsWe conducted a pilot trial to compare the effects of smoke and smokeless moxibustion with a control as a possible supplement to external cephalic version (ECV) for converting breech to cephalic presentation and increasing adherence to cephalic position, and to assess their effects on the well‐being of the mother and child.MethodsWe used a quasi‐experimental design with 3 arms: a smoke moxibustion (SM) (n = 20) and smokeless moxibustion (SLM) (n = 20) groups (20‐min acupoint BL67 stimulation once or twice daily for 10–14 days), and a control group (n = 20). The participants had singleton breech presentations between 33 and 35 gestation weeks. The primary outcome was cephalic presentation at the conclusion of intervention. The secondary outcomes were cephalic presentation at birth and effects on mother and child well‐being.ResultsAt the conclusion of intervention, cephalic presentation was higher in the SLM (60.0%) than the control groups (25.0%), Relative Risk 2.40, 95% Confidence Interval [1.04–5.56]; there was no significant difference for SM. At birth, there were no significant differences in cephalic presentation or well‐being.ConclusionSLM treatment showed an increasing trend towards cephalic presentation at the conclusion of intervention. Although significant differences were not observed at birth possibly due to the small samples and non‐randomization, moxibustion was safe, and not associated with perinatal morbidity and mortality. A randomized controlled trial with a larger sample is warranted to ascertain SLM treatment as a possible ECV supplement for converting and increasing adherence to cephalic position.

Clinical analysis of 40 cases of external cephalic version without anesthesia.

ObjectiveThis study aimed to investigate the success rate, complications, and success-related factors of external cephalic version (ECV) of singleton breech pregnancies after 37 gestational weeks without anesthesia.MethodsWe studied 40 singleton breech pregnancies in women who underwent ECV without anesthesia after 37 gestational weeks from October 2018 to March 2020. On the basis of success of ECV, the women were divided into two groups of the successful group and the failed group. Various factors were analyzed to determine those that affect the success of ECV.ResultsOf the 40 attempts of ECV, 24 (60.0%) were successful and 16 (40.0%) failed. With regard to success-related factors, parity was significantly different between the two groups, with more multiparous women in the successful group than in the failed group. However, none of the other factors were significantly different between the groups. Fetal outcome was good in all of the cases. Ultimately, 3 cesarean sections were performed in the successful group and 16 were performed in the failed group.ConclusionsECV of breech presentation after the 37th week of pregnancy without anesthesia is an effective and relatively safe alternative, and can effectively reduce the cesarean section rate.

Nitrous oxide analgesia for external cephalic version: A randomized controlled trial

Study objectiveOur study sought to determine whether or not nitrous oxide analgesia decreases pain compared to oxygen placebo during external cephalic version for breech presentation. Procedural success may be limited by pain and anxiety. Although neuraxial anesthesia has been studied extensively for these procedures, many centers lack resources for routine use. Nitrous oxide is noninvasive, has minimal side effects and requires limited facilities. We hypothesized that its analgesic properties would decrease pain compared to oxygen placebo during external cephalic version. DesignDouble-blinded randomized placebo-controlled trial. SettingLabor and delivery triage room. PatientsForty-eight patients, ≥18 years of age, 37-weeks' gestation or beyond, singleton pregnancy, breech presentation, and American Society of Anesthesiology physical status I-III, having an external cephalic version. InterventionsPatients undergoing external cephalic version were randomized to receive self-administered 50% nitrous oxide/50% oxygen versus 100% oxygen placebo. MeasurementsThe primary outcome measured was intra-procedural pain. Secondary outcomes were intra-procedural anxiety, patient satisfaction, and procedure difficulty. Main resultsForty-eight patients were enrolled; 23 received nitrous oxide and 25 received oxygen. No difference was noted in mean pain scores (nitrous oxide 5.5 ± 2.3, placebo 5.4 ± 2.7, [CI95% = −1.40, 1.51]; P = 0.943) or anxiety scores (nitrous oxide 1.6 ± 2.0, placebo 1.2 ± 1.8, [CI95% = −0.74, 1.45]; P = 0.515). Procedural difficulty (1–10 scale, 1 = very easy, 10 = extremely difficult) was not different between groups (nitrous oxide 6.1 ± 2.2, placebo 6.1 ± 3.2, [CI95% = −1.54, 1.66]; P = 0.944). There was a significant increase in the number of version attempts in the nitrous oxide group (nitrous oxide 3.9 ± 1.9, placebo 2.8 ± 1.4, [CI95% = 0.05, 2]; P = 0.046). Patient satisfaction was significantly lower in the nitrous oxide group (nitrous oxide 4.3 ± 4.0, placebo 6.9 ± 3.6, [CI95% = −4.93, −0.34]; P = 0.025). ConclusionDespite the desirable properties of nitrous oxide, there was no analgesic benefit over oxygen for external cephalic version. Its routine use for these procedures was not supported.