Abstract:Women who have had a successful external cephalic version for breech presentation are at increased risk for cesarean delivery and instrumental vaginal delivery as compared with women with a spontaneous cephalic presentation. Nevertheless, with a number needed to treat of three, external cephalic version still remains a very efficient procedure to prevent a cesarean delivery.
“…Due to the data structure, the study population was derived by combining: [1] women who had a record of ECV at ≥36 weeks during pregnancy, and [2] breech-presenting singleton infants born at ≥36 weeks, taken from birth records (Fig. 1).…”
Section: Methodsmentioning
confidence: 99%
“…1). To examine the uptake of ECV, the population of breech pregnancies were classified retrospectively into 3 groups: [1] women with ECV, [2] women potentially eligible for ECV, and [3] women considered ineligible for ECV.Fig. 1Selection of study population from available records and definition of the study groups.…”
Section: Methodsmentioning
confidence: 99%
“…External cephalic version (ECV) is an effective manipulative procedure for turning a breech-presenting fetus so that it presents head-first for vaginal delivery [1, 2]. Adverse outcomes associated with ECV are rare [3] and the procedure is cost-effective when compared to a scheduled caesarean section [4].…”
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.
“…Due to the data structure, the study population was derived by combining: [1] women who had a record of ECV at ≥36 weeks during pregnancy, and [2] breech-presenting singleton infants born at ≥36 weeks, taken from birth records (Fig. 1).…”
Section: Methodsmentioning
confidence: 99%
“…1). To examine the uptake of ECV, the population of breech pregnancies were classified retrospectively into 3 groups: [1] women with ECV, [2] women potentially eligible for ECV, and [3] women considered ineligible for ECV.Fig. 1Selection of study population from available records and definition of the study groups.…”
Section: Methodsmentioning
confidence: 99%
“…External cephalic version (ECV) is an effective manipulative procedure for turning a breech-presenting fetus so that it presents head-first for vaginal delivery [1, 2]. Adverse outcomes associated with ECV are rare [3] and the procedure is cost-effective when compared to a scheduled caesarean section [4].…”
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.
“…A large meta-analysis of 46,641 patients found an increased risk for cesarean section after successful ECV with an OR of 2.2, and likewise increased risks for dystocia, fetal distress, and instrumental vaginal delivery. Nevertheless, the authors concluded that ECV is a very efficient procedure, as the number needed to prevent a cesarean section was only 3 [10]. Another meta-analysis similarly found the C/S rate after successful ECV to be 2 times as high as after spontaneous cephalic-presenting pregnancies [11].…”
Background: Achieving a cephalic position after a successful external cephalic version (ECV) is desired to result in delivery and fetal outcomes that are similar to those of deliveries following spontaneous cephalic presentation. Methods: We performed a retrospective cohort study including patients with successful ECV following fetal breech position (ECV cohort, n = 47) or with a singleton spontaneous cephalic pregnancy at ≥37 weeks of gestational age (control group, n = 7,456) attempting a vaginal delivery between 2010 and 2013 at the University Hospital Ulm. The mode of delivery and fetal outcome parameters were compared between these 2 groups using nonparametric statistics. Results: ECV cohort and control group did not differ with respect to maternal age, parity, gestational age at birth, and fetal gender. There were no significant differences between the 2 groups with regard to all parameters indicating fetal outcome. However, the rate of cesarean sections was higher after successful ECV compared to spontaneous cephalic presentation (27.7 vs. 12.8%, OR 2.615). Conclusion: While vaginal delivery is less likely to happen after a successful ECV compared to spontaneous cephalic singleton pregnancies, fetal outcome parameters showed no difference between the 2 groups. Physicians should be counseling and encouraging women to attempt ECV, as it is a safe and effective procedure.
“…s 3,1 poskusa ZO enemu carskemu rezu. Zmanjšanje števila carskih rezov kaže reProDukcIJa človeka večina raziskav s tega področja (31)(32)(33)(34). Potrdila ga je zadnja Cochraneova raziskava Hofmeyrja in sodelavcev (12).…”
IzvlečekIzhodišča: Večino plodov v medenični vstavi ob predvidenem datumu poroda porodimo s carskim rezom. Strokovne smernice ob zagotovitvi določenih pogojev priporočajo poskus zunanjega obrata ploda v glavično vstavo in s tem zmanjšanje deleža carskih rezov. Želeli smo analizirati dejavnike uspešnosti zunanjega obrata in preveriti hipotezo, da se z izvajanjem zunanjega obrata izognemo znatnejšemu številu carskih rezov.Metode: V raziskavo smo vključili vse poskuse zunanjega obrata ploda na glavico pri enoplodni nosečnosti po dopolnjenem 36. tednu nosečnosti na Ginekološko-porodniškem oddelku Splošne bolnišnice Izola od leta 2002 do 2010.Rezultati: Od 143 poskusov zunanjega obrata je bil ta uspešen pri 68 nosečnicah ali v 47,6 %. Na uspešnost posega so najbolj vplivali večja količina plodovnice, visok položaj vodilnega plodovega dela v medenici ter prečna ali poševna lega ploda. S 100 poskusi zunanjih obratov se izognemo 32 carskim rezom oziroma enemu carskemu rezu s 3,1 poskusa.Zaključki: Raziskava je potrdila, da z zunanjim obratom na glavico lahko zmanjšamo število carskih rezov zaradi medenične vstave. Uspešnost posega je bila primerljiva z drugimi raziskavami kljub manjši uporabi zdravil.
AbstractBackground: Almost all babies in breech presentation at term are delivered by caesarean section. Professional guidelines recommend an attempt of external cephalic version to reduce breech presentations at birth and thus the proportion of caesareans. Our aim was to analyse the clinical and ultrasound factors to predict the outcome of version and check the hypothesis, if the implementation of the external cephalic version helps to reduce the number of caesareans.
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