External Cephalic Version-related Risks: A Meta-analysis

Grootscholten, Kim; Kok, Marjolein; Oei, S.G.; Mol, Ben Willem J.; Post, J.A. van der

doi:10.1097/01.aoa.0000362097.33827.fc

Cited by 37 publications

(56 citation statements)

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“…Many cesareans can, and probably should, be reasonably avoided. This study lends support to the routine use of ECV, a safe procedure, 8 as one component of an overall approach to reducing the cesarean rate. With trial of labor after cesarean rapidly disappearing, the opportunity to avoid a primary cesarean delivery is a terrible thing to waste.…”

supporting

confidence: 62%

External cephalic version: a terrible opportunity to waste

Lyell

Caughey

2009

J Perinatol

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Breech presentation complicates 3 to 4% of pregnancies at term. Since the Term Breech Trial was published, 1 the rate of breech vaginal birth has fallen precipitously. Breech vaginal birth is no longer considered the standard of care and the vast majority of singleton breech presentations lead to a cesarean delivery. Meanwhile, the cesarean delivery rate in the United States has reached an all-time high of 31.1% 2 and continues to increase annually. The primary cesarean delivery rate is similarly at an alltime high despite recommendations from Health People 2010 for a primary cesarean rate of 15%. 3 Of these, an increasing number of primary cesarean deliveries are performed for breech presentation. 4 The reasons fewer women today opt for attempted external cephalic version (ECV) are less clear. Patient request and physician ambivalence may be involved, driven by the concern that even if successful, ECV may result in a cesarean. In this issue, Clock et al. provide compelling evidence from a matched case-control study that women who have undergone a successful ECV are not at increased risk for cesarean delivery.The authors matched 197 women who had undergone successful ECV with the next 2 women of similar parity, gestational age, delivery history and type of labor who presented for labor management. They found successful ECV did not increase the chance of a cesarean or operative vaginal delivery. Even patients with a prior cesarean who underwent ECV had a similar cesarean rate when compared with the matched control group. The discrepancy in this finding from prior studies is not entirely clear. However, the authors did take great care to match appropriately study patients to controls with similar obstetric characteristics.Of great concern is the steady fall in ECV procedures seen during the study period, from 1998 to 2006. The reasons for this decline were not studied by the authors, but their postulates, that physician threshold for cesarean delivery is lower and patient request is more common, are plausible, and this topic deserves further study.Since the peak of vaginal birth after cesarean delivery in 1996, the rate of trial of labor after cesarean has steadily fallen as well and is currently less than 10%. 2 Yet, complications from cesareans are well known. With each cesarean, a woman's risk increases for abnormal placentation, hysterectomy, adhesion-related complications such as bowel, ureteral, and bladder injury, prolonged operative time, and for the sequelae of such complications including postoperative ventilation, hospital days, transfusion of more than four units of blood 5 and maternal mortality 6 . These risks are magnified when a woman undergoes multiple cesareans. Fetal and neonatal risks due to cesarean delivery are similarly significant. The risk of delivery-related perinatal death during a trial of labor is 11 times greater compared with a planned repeat cesarean delivery. 7 Thus, prevention of the first cesarean is critical for reducing maternal and neonatal cesarean-related morbidities down th...

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supporting

confidence: 62%

External cephalic version: a terrible opportunity to waste

Lyell

Caughey

2009

J Perinatol

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“…Ten of the 11 abruptions resulted in emergency caesarean section. 43,44 Although intracranial bleeding is not reported as a significant complication in these studies, external cephalic version has always been avoided in the case of a known/suspected fetus with a bleeding disorder due to this theoretical risk.…”

Section: Evidence Level 2+mentioning

confidence: 99%

Management of Inherited Bleeding Disorders in Pregnancy

2017

BJOG

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“…Število poskusov po letih se je spreminjalo, prav tako uspešnost (Slika 1), vendar statistično neznačilno. V redkih člankih v literaturi je opisano hitro uče-nje postopka, saj že po 20 primerih uspešnost doseže plato (21). Na uspešnost zunanjega obrata so statistično pomembno vplivali nekateri dejavniki: rodnost ali pariteta nosečnice, količina plodovnice, lega posteljice, palpacija glavice, višina vodilnega plodovega dela in lega ploda.…”

Section: Rezultatiunclassified

Zunanji obrat ploda na glavico v Porodnišnici Izola

Lovšin¹,

Mrkajić²,

Zver-Skomina³

et al. 2017

SlovMedJour

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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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External Cephalic Version-related Risks: A Meta-analysis

Cited by 37 publications

References 0 publications

External cephalic version: a terrible opportunity to waste

External cephalic version: a terrible opportunity to waste

Management of Inherited Bleeding Disorders in Pregnancy

Zunanji obrat ploda na glavico v Porodnišnici Izola

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