External cephalic version at term: a cohort study of 18 years’ experience

Melo, Pedro; Georgiou, Ektoras X; Hedditch, Anita; Ellaway, P.; Impey, Lawrence

doi:10.1111/1471-0528.15475

Cited by 64 publications

(79 citation statements)

References 34 publications

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“…Not surprisingly, both were associated with polyhydramnios and multiparity, which is in accordance with previous studies. 9,15 Nearly 91% of women with a successful ECV delivered vaginally, representing a remarkably low cesarean delivery rate of 9% compared to that reported in a recent meta-analysis. 38 This could be possibly explained by local hospital antepartum and intrapartum practice and a relatively high number of parous women.…”

Section: Discussionmentioning

confidence: 96%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…[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).…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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

Rottenstreich

Weill

Pollack

2019

Birth

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“…In the Cambridge study, the uptake of ECV among eligible women was 65% and this was successful in only 14% of cases. In contrast, in the Oxford study, in which all women with breech presentation were managed in a specialist clinic, the uptake of ECV among eligible women was 90% and this was successful in 49% of cases. In relation to the timing of ECV, a Cochrane review of three trials reported that the success rate is higher if ECV is carried out at 34–35 weeks' gestation, rather than at 37–38 weeks, but at the expense of a higher rate of preterm birth.…”

Section: Discussionmentioning

confidence: 96%

“…A more realistic estimate of the accuracy of routine clinical examination in the detection of non‐cephalic presentation is 44%, as reported in a study from Cambridge, UK 27 . Additionally, a study from Oxford, UK, reported that ultrasound examination confirmed non‐cephalic presentation in only 41% of 7775 pregnancies suspected of breech presentation during routine antenatal care.…”

Section: Discussionmentioning

confidence: 99%

Value of routine ultrasound examination at 35–37 weeks' gestation in diagnosis of non‐cephalic presentation

Castro

Ciobanu

Formuso

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? This study reports the incidence of non-cephalic presentation at a routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation and subsequent management of such pregnancies. What are the clinical implications of this work?Routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation detects non-cephalic presentation in about 5% of pregnancies. Such diagnosis could potentially improve pregnancy outcome by preventing unexpected abnormal presentation in labor and, through external cephalic version, reducing the incidence of non-cephalic presentation. ABSTRACTObjective Undiagnosed non-cephalic presentation in labor carries increased risks for both the mother and baby. Routine pregnancy care based on maternal abdominal palpation fails to detect the majority of cases of non-cephalic presentation. The aim of this study was to report the incidence of non-cephalic presentation at a routine scan at 35 + 0 to 36 + 6 weeks' gestation and the subsequent management of such pregnancies. MethodsThis was a retrospective analysis of prospectively collected data in 45 847 singleton pregnancies that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Patients with breech or transverse/oblique presentation were divided into two groups; first, those who would have elective Cesarean section for fetal or maternal indications other than the abnormal presentation, and, second, those who would potentially require external cephalic version (ECV). The latter group was reassessed after 1-2 weeks and, if there was persistence of abnormal presentation, the parents were offered the option of ECV or elective Cesarean section at 38-40 weeks' gestation. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal and pregnancy characteristics provided a significant contribution in the prediction of, first, non-cephalic presentation at the 35 + 0 to 36 + 6-week scan, second, successful ECV from non-cephalic to cephalic presentation, and, third, spontaneous rotation from non-cephalic to cephalic presentation that persisted until delivery.Results First, at 35 + 0 to 36+ 6 weeks, the fetal presentation was cephalic in 43 416 (94.7%) pregnancies, breech in 1987 (4.3%) and transverse or oblique in 444 (1.0%). Second, multivariable analysis demonstrated that the risk of non-cephalic presentation increased with increasing maternal age and weight, decreasing height and earlier gestational age at scan, was higher in the presence of placenta previa, oligohydramnios or polyhydramnios and in nulliparous than parous women, and was lower in women of South Asian or mixed racial origin than in white women. Third, 22% of cases of non-cephalic presentation were not eligible for ECV because of planned Cesarean section for indications other than the malpresentation. Fourth, of those eligible for ECV, only 48.5% (646/1332) agreed to the procedure, which was successful in 39.0% (252/646) of cases. Fifth, the chance of successful...

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Use of external cephalic version in Portuguese public hospitals

Pinto

Clode

Ayres‐de‐Campos

2022

Intl J Gynecology & Obste

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Objective To evaluate the use of external cephalic version (ECV) in Portuguese public hospitals with maternity services, as well as exploring the main motives for not offering the technique. Methods A cross‐sectional observational study was conducted involving an online survey with 34 questions, accessed via an email addressed to all Heads of Department of Portuguese state‐owned hospitals with maternity services. In centers where the technique was performed, information was requested on success rates, contraindications for the procedure, and practical aspects related to its use. In centers where ECV was not offered, the underlying reasons for this were queried. Results Answers were received from 41 out of the 43 state hospitals with maternity services (95.3%). Sixteen hospitals perform the technique (39%), with reported annual numbers ranging from 3 to 51, and success rates ranging from 25% to 85% (12 respondents). The main reasons for not offering the technique were lack of experience and lack of conditions to perform it safely. Most centers (87.8%) reported that they would welcome hands‐on training in ECV. Conclusion ECV is used in a minority of Portuguese state‐owned hospitals. Efforts are needed to achieve a wider implementation of the technique, with a particular focus on simulation‐based training.

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External cephalic version at term: a cohort study of 18 years’ experience

Abstract: External cephalic version can safely be performed with most breech presentations.

Cited by 64 publications

References 34 publications

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

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

Value of routine ultrasound examination at 35–37 weeks' gestation in diagnosis of non‐cephalic presentation

Use of external cephalic version in Portuguese public hospitals

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