Outcome of external cephalic version (ECV) in singleton pregnancy with uncomplicated breech presentation at term in a tertiary rural hospital

Abstract

INTRODUCTIONBreech presentation is the most common malpresentation. The incidence of breech presentation at term is 3-4%. Management of breech presentation at term is always being a topic of controversy. Day by day ECV is becoming a loosing Art. As delivery by Elective LSCS for Breech is associated with significantly lower neonatal mortality and morbidity, many obstetricians and pregnant women choose not to deliver breech babies vaginally. This is a significant contributing factor in increasing the caesarean rate and associated maternal morbidity.ECV has been definitely proven to decrease the incidence of breech at term.1 After rigorous scientific appraisal of several randomized controlled trials there has been renewed interest in external cephalic version in the last few years.2 American College of Obstetricians and Gynaecologists (2001) recommended that efforts should be made to reduce breech presentation by external cephalic version. 3 ABSTRACTBackground: Breech presentation is the most common malpresentation. The incidence of breech presentation at term is 3-4%. Objective of present study was to evaluate the outcome of external cephalic version (ECV) in singleton pregnancy with uncomplicated breech presentation at term in tertiary rural hospital and to analyze the immediate and ultimate outcome of external cephalic version done in term pregnancy with breech presentation with gestational age ≥37 weeks. Methods: This study was conducted at MIMER Medical college and BSTR Hospital, Talegaon Dabhade. Patients with breech presentation at term were studied over duration of 2½ years. 50 patients with breech presentation ≥37 weeks fulfilling the inclusion criteria underwent External cephalic version (ECV). Further obstetric progress is studied with the perinatal outcome and results were analyzed. Results: ECV was successful in 66% cases, out of which 88% cases had vaginal delivery and 12 % cases had LSCS for obstetric indication. Perinatal outcome was not affected with ECV. Conclusions: ECV at term significantly reduces both the incidence of breech delivery and caesarean section rate for breech delivery. ECV does not adversely affect the maternal and perinatal outcome.

Outcomes of external cephalic version for antenatal women with breech presentation in a secondary hospital in Vellore, Tamil Nadu - a retrospective review

“…Among the neonatal outcomes, there was a slightly higher proportion of perinatal morbidity (5-minute APGAR score <7)/mortality, following unsuccessful ECV compared with successful ECV (1.4% vs 0.8%, respectively) but this difference was not significant ( Table 4 ). A similar study done in a rural tertiary care hospital in Maharashtra reported all babies to have APGAR of 9 at 5 minutes and no fetal complications or deaths attributable to ECV ( 14 ). No difference in perinatal outcome has been seen in other higher-powered studies either, rather showing comparable outcomes in both groups ( 15 ).…”

Pregnancy outcome of external cephalic version in singleton pregnancy with breech presentation at term

“…This was similar to the vaginal delivery rate reported in studies conducted by Malhi R et al (83.3%) and Vedpathak et al (88%) and significantly higher when compared to study conducted by Kathpalia et al (50%). [4][5][6] As inferred from this study; external cephalic version is an effective method in reducing the rate of cesarean delivery in cases of breech presentation. This benefit holds higher significance as it also reduces the rate of secondary cesarean delivery in future pregnancies in these women.…”

“…These findings support the hypothesis of increased success rate with parity as shown in different other studies. [4][5][6] Spontaneous reversion to breech presentation after successful ECV can occur in very few cases and only one instance was recorded in this study. Similarly, spontaneous version after failed ECV was reported in two cases after failed attempt in this study.…”

“…The success rate observed in this study (63%) is in accordance with most of the related studies conducted in India. 4,5 The success rate varied markedly along with parity from 38% in nulliparous to 83% in multiparous women. The procedure failed in 24 women; out of which 15 were nulliparous lady.…”