Version For Breech Presentation Research Articles

Rebozo and External Cephalic Version in breech presentation (RECEIVE): A randomised controlled study.

To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth. A multicentre randomised controlled trial. Three university hospitals in Copenhagen, Denmark. Pregnant women with a breech or transverse presentation at 35weeks or more of gestation eligible for ECV. We compared rebozo before ECV with ECV alone. The randomisation was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3-5days before the scheduled ECV. Analyses were by intention-to-treat. The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n=187) or control (n=185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention. In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth. Home-based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth.

Spontaneous cephalic version and risk factors for persistent breech presentation: a longitudinal retrospective cohort study

Aims To address the rate of spontaneous version in breech presentation until term and explore the risk factors for persistent breech presentation diagnosed by the second-trimester ultrasound examination. Methods This is a retrospective cohort study of pregnant women with a singleton pregnancy who had their ultrasound examination conducted at the time of 22–26 weeks of gestation in the Guangzhou Women and Children’s Medical Center. Cox regressions were applied to determine the strength of association between selected risk factors and persistent breech presentation. Results Among 25,313 pregnant women eligible for analysis, the prevalence of breech presentation was 36.8% (9,306/25,313) at 22–26 weeks of gestation, 4.2% (376/8,876) of which would remain in the breech presentation at the onset of labor (adjusted odds ratio [aOR], 0.39, 95% confidence interval [CI], 0.17–0.88). Multiparity (aOR, 0.39, 95% CI, 0.30–0.52) and longer gestational weeks at delivery (aOR, 0.50, 95% CI, 0.44–0.56) were associated with a lower risk of persistent breech presentation (PBP). Female fetus, lateral or fundal placenta, and known uterine malformation was each associated with an increased odd of 1.4 (aOR, 95% CI, 1.11–1.70), 2.4 (aOR, 95% CI,1.50–3.73), 3.1 (aOR, 95% CI, 1.71–5.53) and 8.7 (aOR, 95% CI, 3.84–19.84) times in the persistent breech presentation, respectively. Conclusion The prevalence of the breech presentation was 36.8% between 22 and 26 weeks of gestation, and approximately 4% would have been in the persistent breech presentation until the onset of labor. Higher educational attainment, multiparity and longer gestational weeks at delivery were significantly decreasing the risk of persistent breech presentation. While the pregnant women with age >40 years, female fetus, lateral or fundal placenta and known uterine malformation were associated increased risk of persistent breech presentation.

Prediction of Success in External Cephalic Version for Breech Presentation at Term: Correction.

Prediction of Success in External Cephalic Version for Breech Presentation at Term: Correction.

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

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

Reduction of maternal and neonatal harm through prevention of the primary Cesarean section

While there are clear life-saving indications for Cesarean section (C-section), rates of this procedure have seen a continued rise without a concomitant improvement in maternal or neonatal outcomes. There is some evidence that outcomes may actually be worse for low-risk C-sections versus vaginal delivery. However, this is not necessarily common knowledge for healthcare providers, and therefore, their patients. Measures to safely reduce the C-section rate target management of labour arrest and specific indications for progression to C-section. In the active phase of the first stage of labour, C-section should be considered only in cases of failure to progress after 4 hours of adequate uterine contraction, or 6 hours of inadequate contraction. In the second stage of labour, expectant management of 3 hours of pushing in nulliparous women and 2 hours in multiparous women is safe and appropriate. Furthermore, manual rotation and operative vaginal delivery in the second stage are reasonable alternatives to C-section. Expectant management is also appropriate for certain non-reassuring fetal heart rate tracings. In post-dates pregnancies, induction of labour reduces both rates of C-section and neonatal mortality. Finally, evidence supports the use of external cephalic version in breech presentation as well as a more conservative approach to suspected macrosomia and multiple pregnancy. Taken together, these measures target the most common indications for progression to C-section and can allow us to safely reduce the C-section rate. Educating patients and physicians on the risks of the procedure and reasonable alternatives can improve outcomes for mothers and neonates.

Patients and professionals barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands

Patients and professionals barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands

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

Fear for external cephalic version and depression: predictors of successful external cephalic version for breech presentation at term?

BackgroundObjective was to determine whether fear for external cephalic version (ECV) and depression are associated with the success rate of ECV in women with a breech presentation at term.MethodsProspective study conducted in the Catharina Hospital Eindhoven between October 2007 and May 2012. Participants fulfilled The Edinburgh Depression Scale (EDS) questionnaire and expressed their degree of fear on a visual analogue scale from one to ten before ECV. Obstetric factors were evaluated as well. Primary outcome was the relation between psychological factors (fear for ECV and depression EDS scores) and ECV success rate. Secondary outcome was a possible relation between fear for ECV and increased abdominal muscle tension.ResultsThe overall success rate was 55% and was significantly lower (p < 0.001) in nulliparous women (44.3%) compared with parous women (78.0%). Fear for ECV and depression EDS-scores were not related with ECV success rate. Parity, placental location, BMI and engagement of the fetal breech were obstetric factors associated with ECV outcome. There was no relation between fear for ECV and abdominal muscle tone.ConclusionFear for ECV and depression were not related with ECV success rate in this study. Engagement of the fetal breech was the most important factor associated with a successful ECV.Trial registrationEBIS: The Eindhoven Breech Intervention Study, NCT00516555.

Acupuncture in Pregnancy

Acupuncture is an excellent tool for the treatment of various conditions during pregnancy. As a non-pharmacological method, it is ideally suited to this delicate time period in a woman's life. Indeed one of its main advantages is arguably the avoidance of unnecessary medication, the potential harms of which are exemplified by the devastation caused by thalidomide, which was of course originally introduced as a treatment for pregnancy-associated nausea and vomiting. Acupuncture may be used antenatally, for labour and delivery, and even during the postnatal period. Given the lack of any evidence of harm following acupuncture treatment during pregnancy,1 which is further highlighted by the accompanying paper by Carr,2 the aim of this editorial is to provide an overview of the current indications for obstetric acupuncture, to share my personal experience in this area, and to offer some practical suggestions for treatment. Much of the acceptance of acupuncture within the scientific community is due to pioneering work that demonstrated its effectiveness for the treatment of nausea and vomiting. While most well-designed studies have focused on chemotherapy-induced or postoperative nausea and vomiting, there is evidence that acupuncture can also be effective in pregnancy-associated nausea and vomiting across the spectrum from morning sickness to hyperemesis gravidarum.3 Around the time of delivery, it has been shown to be effective as a complementary or alternative technique for intrapartum analgesia,4 and acupuncture and/or moxibustion at BL67 is often used to promote cephalic version in breech presentation,5 ,6 typically between 33 and 35 weeks’ gestation. Acupuncture and related techniques may also be used to increase the …

Outcome of external cephalic version in breech presentation

Breech presentation is the most common abnormal foetal presentation with an incidence of 3–4% at term. It is associated with increased perinatal mortality and morbidity irrespective of the route of delivery. There is higher incidence of premature rupture of membranes, premature labour, prolapsed cord, traumatic deliveries, perinatal mortality and morbidity including various birth injuries, which makes breech an unfavourable presentation. Not only is the foetal asphyxia more commonly seen in breech, the incidence of traumatic morbidity like intracranial haemorrhage, visceral injuries, fractures, dislocations, and peripheral nerve injuries are encountered more frequently.1 With the passage of time, the art of assisted breech delivery has suffered significant setback. Most of the cases of unfavourable presentation like breech are subjected to caesarean section in the current obstetric practice. The elective caesarean section does not guarantee the improved outcome of the baby and may also increase the risk for the mother, compared to vaginal delivery.2 This situation is further compounded by current small family norms and fear of litigation. In view of this, converting an unfavourable presentation like breech into cephalic presentation by carrying out an external cephalic version (ECV) is a viable option. With ECV the expected 3–4% incidence of breech presentation at delivery may be reduced to 1%. Besides, ECV may also protect against premature labour, its complications, and permit a higher percentage of term deliveries as 20–30% of obstetric patients with breech presentation deliver prematurely.3 External cephalic version is also a potentially hazardous procedure. There is increased risk of ante partum haemorrhage, foeto-maternal haemorrhage, and foetal distress, rupture of membranes, placental abruption, and cord complications. External cephalic version is a strong stimulant of foeto-placental unit as evident by increased middle cerebral arterial blood flow and increased cell free foetal deoxyribonucleic acid in maternal circulation. In the hands of an experienced surgeon and with aid of tocolytics, ultrasonography, and cardiotocography the overall success rate of the procedure is 77% with very small risk of complications.4 Moreover, low cost, ease of procedure, and patient preparation are the added advantages. The delay to attempt ECV at or after 37 weeks of gestation has obvious advantages like management of complications by emergency caesarean section, giving time for spontaneous version to take place with the requirement of fewer procedures.5,6 Thus, there are some uncertainties related to the role and outcome of ECV in breech presentation. The present study aims to determine the outcome of ECV in breech presentation.

Does the Advice to Assume the Knee-Chest Position at the 36th to 37th Weeks of Gestation Reduce the Incidence of Breech Presentation at Delivery?

Breech presentation remains a hazard for the mother and her fetus. To reduce its incidence at delivery, postural techniques have been used, among which the knee- chest position. The objective of this study was to assess the effectiveness of this position on cephalic version of breech presentation. It was a prospective randomized study in a group of 102 women with viable fetuses in breech presentation at 36 to 37 weeks of gestation. The 49 women of the intervention group assumed the knee-chest position for 15 minutes three times a day for one week. The control group had 53 cases. The study and control groups were reviewed after a week to assess the fetal presentation. The version rate was 61% and 20% in intervention and in control groups, respectively (P value = .03). This position should be advised to women with fetus in breech between 36 and 37 weeks of gestation.

A Randomized Controlled Trial of the Effect of Combined Spinal-Epidural Analgesia on the Success of External Cephalic Version for Breech Presentation

A Randomized Controlled Trial of the Effect of Combined Spinal-Epidural Analgesia on the Success of External Cephalic Version for Breech Presentation

130: External validation of a prediction model for successful external cephalic version in breech presentation at term

External cephalic version (ECV) is a relative simple and safe maneuver that reduces the frequency of breech presentation at term and consequently, the number of cesarean deliveries. We previously developed a model for the prediction of successful ECV in women with a singleton breech presentation at term. The model contained data on estimated fetal weight (EFW), parity. amniotic fluid index (AFI) and placenta localization. External validation is a crucial step before a predictive model can be used in daily practice.

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

OBJECTIVE:To compare the success of external cephalic version using spinal analgesia with no analgesia among nulliparas.METHODS:A prospective randomized controlled trial was performed in a tertiary referral center delivery suite. Nulliparous women at term requesting external cephalic version for bre

An exploratory study of women's experiences and key stakeholders views of moxibustion for cephalic version in breech presentation

A phenomenological research approach was taken to explore women's feelings and experiences of using moxibustion for cephalic version in breech presentation. Eight women with an uncomplicated breech presentation at term were offered moxibustion. Qualitative interviews were carried out before and after the treatment and women completed daily logs of their experiences. Women experienced anxieties about the implications of breech presentation and the options offered to them. All women carried out the treatment successfully and overall experiences were positive. Compliance was excellent and women reported few negative effects. The partner's co-operation was important to ensure that the procedure was carried out effectively and safely. Key stakeholders were also interviewed to determine their views on the requirements of implementing moxibustion into the maternity services. The need for research evidence of effectiveness was a priority. In addition, a number of practical issues are suggested for consideration in the implementation of a service or in future research designs.

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial

External cephalic version for breech presentation at term.

To assess the success rate of External Cephalic Version (ECV) at term and its effects on measures of pregnancy outcome. A quasi-experimental study. The study was conducted at Hayatabad Medical Complex, Peshawar, from December 2003 to January 2005. A total of 40 patients were offered ECV over a period of fourteen months. All singleton breech presentations with an otherwise normal antenatal course between 36-41 weeks of gestation were included in the study. Exclusion criteria included contraindications to ECV i.e. multiple pregnancy, oligohydramnios, growth retardation, antepartum hemorrhage, rupture of membranes toxemias of pregnancy, non-reassuring fetal monitoring pattern, previous uterine scar, bad obstetric history, any contraindication to vaginal delivery, labour and patient wishes after thorough counseling. Overall success rate of the procedure and its effect on maternal and fetal outcome was determined. Significance of results was determined using Chi-square test. A total of 40 patients were recruited for the trial. Overall success rate was 67.5% with only 30% being primi-gravida (p < 0.05). Multi-gravida showed higher success rate of 80%. Following successful ECV, spontaneous vaginal delivery was attained in 77.7% (n=21), while caesarean section was performed due to various indications in about 6 cases (p < 0.05). Following failed version, 61.5% (n=8) had elective C/S and only 5 delivered vaginally. Route of delivery did not affect the perinatal outcome except for congenital abnormalities. Following successful ECV, there was only one stillbirth. Overall live births associated with successful version was 96.2% (p < 0.05), while in failed version, there were no fetal deaths. ECV at term appears to be a useful procedure to reduce the number and associated complications of term breech presentation. It is safe for the mother and the fetus and helps to avoid a significant number of caesarean sections.

Cesarean delivery after successful external cephalic version of breech presentation at term

The rate of cesarean delivery was higher in patients with a fetus in cephalic presentation after a successful external cephalic version (ECV) [1,2]. However, other studies do not support those results [3,4]. This controversy is most likely the result of the heterogeneity of the study population. The aim of the present study was to evaluate whether patients who had undergone successful ECV at term were at a higher risk of cesarean section in Japanese population. The present study was performed on patients who were delivered in Osaka University Hospital between 1995 and 2004. Inclusion criteria for ECV