Finding the breech: Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version

Abstract

Results support the need for interventions to increase timely diagnosis of breech presentation as well as improved patient counseling and use of experienced providers for external cephalic version.

State of the breech in 2020: Guidelines support maternal choice, but skills are lost….

“…With a 2018 vaginal birth after cesarean (VBAC) rate of 13.3%, preventing primary cesarean will have a large downstream effect on the overall cesarean rate. External cephalic version (ECV) can potentially prevent about half of these cesareans and appears to be more readily available than planned vaginal breech delivery; however, its use is limited by maternity care providers failing to diagnose approximately one‐third of breech presentations until labor or after 38 weeks . After diagnosis, success rates appear dependent on provider experience, and exclusion of women from being offered ECV based on non–evidence‐based criteria may limit the use of ECV .…”

“…External cephalic version (ECV) can potentially prevent about half of these cesareans and appears to be more readily available than planned vaginal breech delivery; however, its use is limited by maternity care providers failing to diagnose approximately one‐third of breech presentations until labor or after 38 weeks . After diagnosis, success rates appear dependent on provider experience, and exclusion of women from being offered ECV based on non–evidence‐based criteria may limit the use of ECV . If an initial attempt is unsuccessful or the woman is unable to tolerate an attempted external cephalic version, then the use of regional anesthesia (spinal or epidural) should be offered as this has been shown to increase the likelihood of successful ECV and subsequent vaginal birth .…”

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

“…5,6 Published series and meta-analyses have generally focused on ECV success rates, safety, and factors associated with the procedure's outcome. [7][8][9][10][11][12][13][14][15][16] Yet, an experience of a single operator that eliminates practice variations as a confounding factor in ECV success has been understudied.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (14) 9 [5-15] (7) 15 [8-21] (15) <0.001 ECV, external cephalic version. Continuous variables are expressed as median [interquartile range] (mean).…”

Moxibustion for Cephalic Version of Breech Presentation

“…Breech presentation constitutes 3% to 4% of term pregnancies in the United States . External cephalic version (ECV) is the transabdominal manual rotation of the fetus to a cephalic presentation; its effectiveness is 58% .…”