Contraindications for external cephalic version in breech position at term: a systematic review

Rosman, Ageeth N.; Guijt, Aline; Vlemmix, Floortje; Rijnders, Marlies; Mol, Ben Willem J.; Kok, Marjolein

doi:10.1111/aogs.12011

Cited by 41 publications

(24 citation statements)

References 27 publications

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“…Previous caesarean section was the most common reason women were deemed ineligible for ECV with only 2.6% of women with ECV having a history of caesarean section compared to 16.6% in women with breech presentation overall. There may be a clinical perception that with a previous caesarean section there are no safe options, however, there is little evidence that caesarean section should be considered an absolute contraindication for ECV [21]. To the contrary, there is some evidence suggesting the success and associated risks of ECV in women with one previous caesarean section are similar to those in women without such history [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Uptake of external cephalic version for term breech presentation: an Australian population study, 2002–2012

Bin

Roberts

Nicholl

et al. 2017

BMC Pregnancy Childbirth

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BackgroundThe safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012.MethodsData from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks’ gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined.ResultsIn N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV. Compared to women who were eligible but who did not attempt ECV, those who had ECV were more likely to be older, multiparous, overseas-born, public patients at delivery, and to deliver in tertiary hospitals in urban areas (p < 0.01). Fewer women who underwent ECV smoked during pregnancy, fewer were morbidly obese, and fewer had a hypertensive disorder of pregnancy, compared to those who were eligible. Caesarean section occurred in 25.9% of successful compared to 95.6% of unsuccessful ECVs. Infant outcomes did not differ by ECV success.ConclusionsThe majority of women with a breech presentation did not receive ECV. It is unclear whether this is attributable to issues with service provision or low acceptability among women. Policies to improve access to and information about ECV appear necessary to improve uptake among women with term breech presentation. Improved data collection around the diagnosis of breech presentation, ECV attempts, and outcomes may help to identify specific barriers to ECV uptake.

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Section: Discussionmentioning

confidence: 99%

Uptake of external cephalic version for term breech presentation: an Australian population study, 2002–2012

Bin

Roberts

Nicholl

et al. 2017

BMC Pregnancy Childbirth

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“…Nulliparity was found to be independently associated with ECV failure, as previously reported by various authors. 10,23,24 The lower success rate in nulliparous women is thought to be attributed to tenser abdominal muscle and uterus. 25 In addition, we demonstrate that anterior placenta is independently associated with ECV failure, supporting previously published data.…”

Section: Discussionmentioning

confidence: 99%

External cephalic version at term: A 6‐year single‐operator experience

Rottenstreich

Weill

Pollack

2019

Birth

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Background: External cephalic version (ECV) should be offered for patients presenting with a noncephalic pregnancy that are willing to deliver vaginally. Various reports have evaluated predictors for successful ECV. Yet, none have reported a single-operator large cohort experience. We aim to analyze the outcome of referrals for ECV. Methods: We conducted a retrospective cohort study of prospectively collected data.We performed a multivariate analysis of data with respect to ECV procedures performed by a single operator in a 6-year period. Maternal and fetal characteristics were compared between ECV success and failure groups. Results: Six hundred and two women underwent ECV. Of them, ECV was successful in 432 (71.7%). A multivariate binary logistic regression model demonstrated that high liquor volume was a predictor of ECV success (Adj OR 1.17 [95% CI 1.09-1.26]). Failure of ECV was correlated with anterior placenta (0.44 [0.56-0.76]) and nulliparity (0.21 [0.11-0.36]). Adverse events were rare and mostly minor, occurring in 1% of procedures. Conclusions: ECV has a high success rate and a low complication rate, enabling vaginal birth and avoiding cesarean. The role of manipulation of modifiable determinants such as liquor volume should be further assessed in future studies. K E Y W O R D S amniotic fluid index, breech, external cephalic version, malpresentation, placenta | 617 LEVIN Et aL.

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“…32 Interestingly, in a recent systematic review of the published international guidelines regarding ECV, Rosman et al found that there was no consensus or empirical evidence for the majority of cited contraindications to ECV. 33 The authors recommend that the absolute contraindications to ECV should be restricted to oligohydramnios, clinical evidence of placental abruption, maternal conditions such as severe preeclampsia or HELLP syndrome, and signs of fetal distress. 33 Thus, factors such as primiparity, obesity, advanced gestation, excessive fetal weight, or anterior placenta should not limit eligibility.…”

Section: External Cephalic Versionmentioning

confidence: 99%

“…33 The authors recommend that the absolute contraindications to ECV should be restricted to oligohydramnios, clinical evidence of placental abruption, maternal conditions such as severe preeclampsia or HELLP syndrome, and signs of fetal distress. 33 Thus, factors such as primiparity, obesity, advanced gestation, excessive fetal weight, or anterior placenta should not limit eligibility. 33 Associated factors that may improve the success of ECV include multiparity, lack of engagement, frank or complete breech, ability to palpate the fetal head, and low maternal weight.…”

Section: External Cephalic Versionmentioning

confidence: 99%

“…33 Thus, factors such as primiparity, obesity, advanced gestation, excessive fetal weight, or anterior placenta should not limit eligibility. 33 Associated factors that may improve the success of ECV include multiparity, lack of engagement, frank or complete breech, ability to palpate the fetal head, and low maternal weight. 25,31,34 In addition, women with a history of previous cesarean have been shown to have successful ECV, although the risk of uterine rupture is unknown.…”

Section: External Cephalic Versionmentioning

confidence: 99%

See 1 more Smart Citation

Vaginal Breech Birth: Can We Move Beyond the Term Breech Trial?

Hunter¹

2014

J Midwife Womens Health

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Since the publication of the Term Breech Trial in 2000, planned cesarean has become the preferred mode of birth for women whose fetus is in a breech presentation. Over the past 20 years, however, subsequent evidence has not shown conclusively that cesarean birth is safer than vaginal birth for a fetus in a breech presentation when certain criteria are met. Many obstetric organizations support the option of planned vaginal birth for women with a breech presentation under strict prelabor selection criteria and intrapartum management guidelines. The growing trend toward cesarean unfortunately has left midwives and other intrapartum care providers in training with dwindling opportunities to competently master skills for vaginal breech birth. Although simulation training offers opportunities to practice infrequently encountered skills such as vaginal breech birth, it is unknown if this alternative will provide sufficient experience for future generations of clinicians. As a result, women with a breech presentation at term who desire a trial of labor often have limited choices. This article reviews the controversies surrounding the ideal mode of birth created by the Term Breech Trial. Criteria for vaginal breech birth are summarized and the role of simulation explored. Implications for midwifery practice when a breech presentation is diagnosed are also included.

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Contraindications for external cephalic version in breech position at term: a systematic review

Abstract: The present study shows that there is no general consensus on the eligibility of patients for ECV. Therefore we propose to limit contraindications for ECV to clear empirical evidence or to those with a clear pathophysiological relevance.

Cited by 41 publications

References 27 publications

Uptake of external cephalic version for term breech presentation: an Australian population study, 2002–2012

Uptake of external cephalic version for term breech presentation: an Australian population study, 2002–2012

External cephalic version at term: A 6‐year single‐operator experience

Vaginal Breech Birth: Can We Move Beyond the Term Breech Trial?

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