The relationship between amniotic fluid index and successful external cephalic version: a 14-year experience

Boucher, Marc; Bujold, Emmanuel; Marquette, Gérald P.; Vezina, Y.

doi:10.1067/s0002-9378(03)00846-9

Cited by 50 publications

(24 citation statements)

References 10 publications

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“…This, however, is likely to be due to not using tocolysis, to the small number of contraindications to ECV and to the fact that ECV was always attempted in consenting women however difficult it might be. In addition, there was a small percentage of women in whom ECV is less difficult: multiparous women 11 and those of non-white British race. 5 Given that tocolysis is effective at improving ECV success rates, the choice is whether it should be used for all, or where an initial attempt has failed, or just for nulliparous women.…”

Section: Discussionmentioning

confidence: 99%

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Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double‐blinded, placebo‐controlled trial

Impey

Pandit

2005

BJOG

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Background External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Objective To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt.Design Randomised, double-blinded, placebo-controlled trial.Setting UK teaching hospital.Population One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV. Methods Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat. Main outcome measures Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity. Results The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23 -8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14 -0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64-53.62). Maternal and neonatal morbidity remain unchanged. Conclusions The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis.

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Section: Discussionmentioning

confidence: 99%

“…This can result in precautions such as starvation of women, intravenous access and use of an operating theatre. We did not use any of these because we, and others, 11 have not needed to resort to emergency delivery. Therefore, the risks of emergency delivery are much lower than, say, for normal labour, when such precautions are not routine.…”

Section: Discussionmentioning

confidence: 99%

Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double‐blinded, placebo‐controlled trial

Impey

Pandit

2005

BJOG

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“…Not only is the foetal asphyxia more commonly seen in breech, the incidence of traumatic morbidity like intracranial haemorrhage, visceral injuries, fractures, dislocations, and peripheral nerve injuries are encountered more frequently. 1 With the passage of time, the art of assisted breech delivery has suffered significant setback. Most of the cases of unfavourable presentation like breech are subjected to caesarean section in the current obstetric practice.…”

Section: Introductionmentioning

confidence: 99%

Outcome of external cephalic version in breech presentation

Kathpalia

Singh

Sharma

2012

Medical Journal Armed Forces India

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cerebral arterial blood flow and increased cell free foetal deoxyribonucleic acid in maternal circulation. In the hands of an experienced surgeon and with aid of tocolytics, ultrasonography, and cardiotocography the overall success rate of the procedure is 77% with very small risk of complications. 4 Moreover, low cost, ease of procedure, and patient preparation are the added advantages. The delay to attempt ECV at or after 37 weeks of gestation has obvious advantages like management of complications by emergency caesarean section, giving time for spontaneous version to take place with the requirement of fewer procedures. 5,6 Thus, there are some uncertainties related to the role and outcome of ECV in breech presentation. The present study aims to determine the outcome of ECV in breech presentation. MATERIALS AND METHODFifty-nine patients with breech presentation at 34 weeks or more period of gestation were enrolled in the study. All the uncomplicated cases of singleton breech presentation at 34 weeks or more period of gestation were included. Cases of breech presentation < 34 weeks and > 40 weeks period of gestation, breech in labour, multiple gestation, severe oligohydramniosor polyhydramnios (amniotic fluid index [AFI] < 5 or > 25), cases with any contraindication to vaginal delivery, intra-uterine growth restriction, foetal anomalies and uterine malformations, cases with concomitant adverse factors like hypertensive disorders, diabetes mellitus or gestational diabetes mellitus, heart disease, previous caesarean delivery, and placenta previa or abruption placenta have been be excluded from the study. External cephalic version was carried out in selected cases after applying inclusion and exclusion criteria at or after 37 weeks of gestation. An ultrasound examination was performed to confirm the breech position, determine the AFI, and note the placental location and rule out congenital anomalies and the presence of a nuchal cord. The patient was asked to empty her bladder. A non-stress test was performed to confirm the absence of foetal heart rate abnormalities. Tocolysis terbutaline in a dosage of 0.25 mg was administered subcutaneously. The patient was placed in a slight Trendelenburg position to facilitate disengagement/mobility of the breech. After the procedure (regardless of success or failure), a non-stress test and ultrasound examination are performed to exclude foetal bradycardia and to confirm successful version.

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“…Several studies have addressed the prediction of success in ECV [6][7][8][9][10][11][12][13][14][15][16][17] with conflicting evidence. 18 Multiple predictive factors have been proposed in these studies, assessed either by clinical history and physical examination or by ultrasound.…”

Section: 5mentioning

confidence: 99%

Prediction of Success in External Cephalic Version under Tocolysis: Still a Challenge

2015

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RESUMOIntrodução: A versão cefálica externa é o procedimento de rotação fetal para uma apresentação cefálica através de manobras sobre o abdómen materno. Encontram-se descritos na literatura vários factores prognósticos para o sucesso da versão cefálica externa e foram propostos scores preditores, mas a sua verdadeira implicação para a prática clínica é controversa. Pretendemos identificar possíveis factores contributivos para o sucesso de uma tentativa de versão cefálica externa na nossa população. Material e Métodos: Examinámos retrospectivamente 207 tentativas consecutivas de versão cefálica externa sob tocólise conduzidas entre Janeiro de 1997 e Julho de 2012. Consultámos a base de dados do departamento para as seguintes variáveis: raça, idade, paridade, índice de massa corporal, idade gestacional, peso fetal estimado, categoria de apresentação, localização placentária e índice de líquido amniótico. Efectuámos avaliação estatística descritiva e analítica monovariada e regressão binária logística. Resultados: A versão cefálica externa foi bem-sucedida em 46,9% dos casos (97/207). Nenhuma das variáveis incluídas se associou com o desfecho da tentativa após ajuste para factores de confundimento. Discussão: Apresentamos uma taxa de sucesso semelhante ao descrito na literatura. No entanto, ao contrário de estudos anteriores, não associámos nenhuma das variáveis analisadas com o sucesso das tentativas de versão cefálica externa. Acreditamos que esta discrepância poderá ser parcialmente explicada pelo tipo de análise estatística efectuada. Conclusões: Apesar de terem sido identificados numerosos factores de prognóstico para o seu sucesso, o aconselhamento e selecção de grávidas para versão cefálica externa deverão ser cautelosos. Os dados obtidos sugerem que a versão cefálica externa deverá continuar a ser oferecida a todas as grávidas elegíveis independentemente de factores prognósticos de sucesso. Palavras-chave: Apresentação Pélvica; Gravidez; Resultado do Tratamento; Tocólise; Versão Fetal. ABSTRACT Introduction:External cephalic version is a procedure of fetal rotation to a cephalic presentation through manoeuvres applied to the maternal abdomen. There are several prognostic factors described in literature for external cephalic version success and prediction scores have been proposed, but their true implication in clinical practice is controversial. We aim to identify possible factors that could contribute to the success of an external cephalic version attempt in our population. Material and Methods:We retrospectively examined 207 consecutive external cephalic version attempts under tocolysis conducted between January 1997 and July 2012. We consulted the department's database for the following variables: race, age, parity, maternal body mass index, gestational age, estimated fetal weight, breech category, placental location and amniotic fluid index. We performed descriptive and analytical statistics for each variable and binary logistic regression. Results: External cephalic version was successful in 46.9% of ...

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The relationship between amniotic fluid index and successful external cephalic version: a 14-year experience

Cited by 50 publications

References 10 publications

Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double‐blinded, placebo‐controlled trial

Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double‐blinded, placebo‐controlled trial

Outcome of external cephalic version in breech presentation

Prediction of Success in External Cephalic Version under Tocolysis: Still a Challenge

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