Predictors of a successful external cephalic version: A population-based study of Washington state births

Morgan, Erin; Hu, Audrey; Brezak, Audrey; Rowley, SD; Littman, Alyson J.; Hawes, Stephen E.

doi:10.1016/j.wombi.2018.08.001

Cited by 11 publications

(16 citation statements)

References 24 publications

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“…In our study, the success rate of ECV in women without a prior vaginal delivery was 25% (4/16), consistent with the rate documented in the literature, 10 12 and nulliparous women were less likely to have an attempted ECV. This does suggest either a patient or provider bias toward not attempting ECV in these nulliparous women who have a lower rate of successful ECV and are also most at risk of cesarean delivery.…”

Section: Discussionsupporting

confidence: 91%

“…Given this lack of data on ECV practices in the United States, we sought to determine the rate of ECV uptake at one large tertiary care hospital and to determine the differences in patient characteristics between women who did and did not undergo attempted ECV. In particular, ECV success rates are reported to be lower in nulliparous women, 10 12 but there is little data available regarding the uptake of the procedure in this group. We hypothesized that because of the lower reported success rates of ECV, women without a prior vaginal delivery would be less likely to undergo an attempted ECV.…”

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confidence: 99%

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Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term

Limaye

Abdullahi

Has

et al. 2019

AJP Rep

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Objective To assess differences in patient characteristics between women who did and did not undergo attempted external cephalic version (ECV) for fetal malpresentation at term. Study Design This was a retrospective cohort study of women with a singleton gestation and noncephalic presentation at > 37.0 weeks between October 2014 and October 2015. We compared demographic and clinical characteristics of women who did and did not undergo attempted ECV and assessed the reasons that women did not attempt ECV. Results Among 215 women, only 51 (24%) attempted ECV. There were no differences in age, race, insurance type, or body mass index between women who underwent attempted ECV and those who did not. Women who underwent ECV were significantly more likely to have had a prior vaginal delivery (69 vs. 36%, p < 0.001). Seventy-six women (46%) declined ECV. Women who declined ECV were more likely to be nulliparous than those who accepted the procedure (66 vs. 29%, p < 0.001). Among women who had ECV, the success rate was 55%. There were no adverse events after attempted ECV in this cohort. Conclusion Among women with fetal malpresentation at term, those without a prior vaginal delivery were significantly less likely to undergo attempted ECV.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term

Limaye

Abdullahi

Has

et al. 2019

AJP Rep

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“…It is worth mentioning that though amnioinfusion and oral hydration could improve the amount of amniotic uid, which could not obviously improve the success rate of ECV [14,40]. Stature of the candidates was the second important indicator to select the candidates during our procedure, because thickness of the abdominal wall directly affect the di culty of grasping of the fetal head and buttocks [41,42]. BMI of the patients ranged from 21.5 to 31.6 in our study, with no difference between the successful and failed group, which might due to the strict screening criteria in our institution.…”

Section: Discussionmentioning

confidence: 99%

Experiences with High Success Rate of External Cephalic Version and Comparisons of Different Tocolysis for Risk-effective version based on a bayesian network meta-analysis

Yunyun¹,

Yu²,

Li³

et al. 2020

Preprint

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Background: External cephalic version (ECV) has been proved effectively in reducing the cesarean section rates, but the success rates of the procedure are uneven. Experiences of ECV with high success rate were concluded in this paper. And in order to evaluate the efficiency of the applied tocolytic agents, a corresponding bayesian-network meta-analysis was conducted.Methods: Through retrospective analysis of eighty-four single pregnant women with breech presentation near or at term who received ECV from Dalian Maternal and Child Health Care Hospital from April 2017 to November 2019, influence factors associated with the success rate of ECV were analyzed. Meanwhile, a bayesian-network meta-analysis including sixteen eligible randomized controlled trials (RCTs) about comparisons of five common tololytic agents and placebo with 3468 participants searched from Pubmed, Cochrane library and Embase databases until May 20, 2019 was conducted to identify the efficiency of ritodrine and terbutaline applied in the authors’ procedures. Results: The ECV procedures were conducted by a skilled obstetrician through strict selection of the candidates. Oral ritodrine, intravenous terbutaline in combination with epidual analgesia were applied as interventions. Success rate of ECV reached 90.48% (76/84) and the overall vaginal delivery rate is up to 88.16% (67/76). Only one patient reverted to breech presentation due to loose of the bellyband. Among the possible variables, amniotic fluid index were identified to have significantly relationship with the success rate of ECV. As the bayesian network meta-analysis proved: terbutaline, salbutamol and ritodrine played more important roles than nitroglycerine and nifedipine on the success rate of ECV. But salbutamol was found to have more common side effects than terbutaline and ritodrine.Conclusions: We conclude that factors influencing the success rate of ECV mainly include: 1. characteristics of the mothers and fetuses, 2. interventions, 3. skills of the surgeon. During ECV process, selection of patients with enough amniotic fluid and proper stature with no contraindications is essential. And a more detailed scoring standard according to the possible influence indicators of the mothers and fetuses for the feasibility of ECV should be set up in the future. Besides, application of terbutaline and ritodrine as tocolytic agents during ECV procedure were considered to be effective for increasing successful versions.

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“…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).…”

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confidence: 99%

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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Predictors of a successful external cephalic version: A population-based study of Washington state births

Cited by 11 publications

References 24 publications

Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term

Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term

Experiences with High Success Rate of External Cephalic Version and Comparisons of Different Tocolysis for Risk-effective version based on a bayesian network meta-analysis

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

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