External Cephalic Version and Reducing the Incidence of Term Breech Presentation

doi:10.1111/1471-0528.14466

Cited by 78 publications

(51 citation statements)

References 60 publications

(85 reference statements)

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“…Dabei ist auch zu berücksichtigen, dass im Falle der seltenen Komplikation des Notfallkaiserschnittes (laut unserer Umfrage < 1%), bei ÄW ab 37 + 0 SSW die Entbindung eines reifen Kindes erreicht werden kann. Auch das RCOG empfiehlt die ÄW ab 37 + 0 SSW, bei Nullipara auch ab 36 + 0 SSW [14].…”

Section: Diskussionunclassified

“…Dementsprechend wird auch in der Leitlinie des RCOG eine zurückliegende Sectio nicht als Kontraindikation angesehen. Vielmehr sollten die Schwangeren darüber informiert werden, dass in diesem Fall kein erhöhtes Risiko zu bestehen scheint [14]. Die praktische Durchführung der ÄW scheint bei den meisten Teilnehmern dieser Umfrage nach einem ähnlichen Schema abzulaufen: Eine vaginale Untersuchung zur Beurteilung der Fixation des fetalen Steißes wird von der Mehrheit nicht für erforderlich gehalten.…”

Section: Diskussionunclassified

“…Theoretische Bedenken der Autoren dieser Studien sind, dass die Anästhesie durch begleitende Hypotension zu einem längeren Krankenhausaufenthalt führen kann [26]. Das RCOG empfiehlt die Regionalanästhesie nur im Falle eines erneuten Wendungsversuches, falls ein erster Versuch schmerzbedingt gescheitert ist [14].…”

Section: Diskussionunclassified

“…nen, wie Plazentalösung, schwere Präeklampsie oder pathologische Doppler-/Kardiotokografiebefunde (CTG) [9,14].…”

Section: Introductionunclassified

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Current Approach for External Cephalic Version in Germany

Kohls

Gebauer

Flentje

et al. 2020

Geburtshilfe Frauenheilkd

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Introduction Fetal breech presentation at terms occurs in 3 – 6% of pregnancies. External cephalic version can reduce the number of cesarean sections and vaginal breech deliveries. Different approaches are used to carry out external cephalic version. This study looked at the different approaches used in Germany and compared the approach used with the recommendations given in German and international guidelines. Material and Methods An anonymized online survey of 234 hospitals in Germany was carried out in 2018. In addition to asking about hospital structures, questions also focused on how external version was carried out in practice (preparations, tocolysis, anesthetics, etc.), on relative and absolute contraindications and on the success rate. Results 37.2% of the hospitals approached for the survey participated in the study. Of these, 98.8% performed external version procedures. The majority of participating hospitals were university hospitals (26.4%) and maximum care hospitals (35.6%) with an average number of more than 2000 births per year (60.9%). External cephalic version is the preferred (61.7%) obstetrical procedure to deal with breech presentation, rather than vaginal breech birth or primary cesarean section. 45.8% of respondents carry out external version procedures on an outpatient basis, and 42.1% of hospitals perform the procedure as an inpatient intervention, especially from the 37th week of gestation. Prior to performing an external version procedure, 21.6% of surveyed institutions carry out a vaginal examination to evaluate possible fixation of the fetal rump. 95.5% of institutions used fenoterol for tocolytic therapy; the majority using it for continuous tocolysis (70.2%). 1 – 3 attempts at external version (8.4%) were usually carried out by a specific senior physician. In most cases, no analgesics were administered. The reported rate of emergency cesarean sections was very low. The most common indication for emergency C-section was pathological CTG (56,7%). The assessment of relative and absolute contraindications varied, depending on the surveyed hospital. 67.5% asked patients to empty their bladders before carrying out external version, while 10.8% carried out external version when the bladder was filled. The reported success rate was more than 45%. After successful version, only 14.8% of hospitals arranged for patients to wear an abdominal binder. For 32.4%, the decision to apply an abdominal binder was taken on a case-by-case basis. Conclusion The approach used in Germany to carry out external cephalic version is based on the (expired) German guideline on breech presentation. Based on the evidence obtained, a number of individual recommendations should be re-evaluated. More recent international guidelines could be useful to update the standard procedure.

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Section: Diskussionunclassified

“…nen, wie Plazentalösung, schwere Präeklampsie oder pathologische Doppler-/Kardiotokografiebefunde (CTG) [9,14].…”

Section: Introductionunclassified

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Current Approach for External Cephalic Version in Germany

Kohls

Gebauer

Flentje

et al. 2020

Geburtshilfe Frauenheilkd

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“…In addition to this, recent evidences support the possibility to offer women, in selected cases, external cephalic version in case of breech presentation at term. [21] In this scenario, in 2006, the Italian Region -Laziowhere our institution Fondazione Policlinico Universitario A. Gemelli (FPG) -IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) -is located, introduced a list of performance indicators based on quality standards. These indicators are driven by strong clinical recommendations and aim to ensure the quality of health care organization, improving safety of care and helping health managers to understand how change occurs, in order to develop strategies that lead to innovation.…”

Section: Group 10mentioning

confidence: 99%

A multi-approach management intervention can lower C-section rate trends: The experience of a Third Level Referral Center

Belvis

Neri

Angioletti

et al. 2018

JHA

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Objective: To report the experience developed in a Third Level Referral Center in performing a multifaceted intervention strategy to reduce Caesarian Sections (CS) rate. A comparison of our results with the performance of the best Italian hospitals for number of deliveries and CS has been performed.Methods: A monitoring system was set up, based on a prospective collection of all deliveries from 2013 to 2017, according to Robson’s classification. Data have also been collected retrospectively at a regional and national level to compare our results to other institutions. The multi-approach intervention consisted of evidence based tools: process management, training, multiprofessionalism, development of planning and control systems, continuous monitoring, audit and feedback.Results: The percentage of primary CS decreased from 26.71% in 2013 to 15.03% in 2017 (RR adjusted considering the regional average: 0.87 in 2013; 0.57 in 2017, p < .001). A raise of 19.76% in the annual volume of deliveries was registered. Such results have also been confirmed after comparing to the best performing Italian centers. From 2013 to 2016 the percentage of primary CS decreased from 27.02% to 18.04% (RR adjusted considering the regional average: 1.04 in 2013, p > .05; 0.74 in 2016, p < .001), while there was an increase in the annual volume of deliveries from 3,311 to 4,219.Conclusions: Our study confirms that multifaceted interventions can strengthen a continuous quality and safety improvement approach. This is of crucial relevance in the obstetric field and in the Italian country, where overall performance in CS needs to be improved.

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