Effect of maternal intravenous fluid therapy on external cephalic version at term: a prospective cohort study

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

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.

Amnioinfusion for women with a singleton breech presentation and a previous failed external cephalic version: a randomized controlled trial

PURPOSE

Our trial aimed to assess the effectiveness of amnioinfusion for a second attempt at external cephalic version (ECV).

MATERIAL AND METHODS

This open randomized controlled trial was planned with a sequential design. Women at a term ≥36 weeks of gestation with a singleton fetus in breech presentation and a first unsuccessful ECV were recruited in two level-3 maternity units. They were randomly allocated to transabdominal amnioinfusion with a 500-mL saline solution under ultrasound surveillance or no amnioinfusion before the second ECV attempt. Trained senior obstetricians performed all procedures. The primary outcome was the cephalic presentation rate at delivery. Analyses were conducted according to intention to treat (NCT00465712).

RESULT

Recruitment difficulties led to stopping the trial after a 57-month period, 119 women were randomized: 59 allocated to amnioinfusion + ECV and 60 to ECV only. Data were analyzed without applying the sequential feature of the design. The rate of cephalic presentation at delivery did not differ significantly according to whether the second version attempt was or was not preceded by amnioinfusion (20 versus 12%, p = .20). Premature rupture of the membranes occurred for 15% of the women in the amnioinfusion group.

CONCLUSION

Amnioinfusion before a second attempt to external version does not significantly increase the rate of cephalic presentation at delivery.

An Update on Maternal Hydration Strategies for Amniotic Fluid Improvement in Isolated Oligohydramnios and Normohydramnios: Evidence from a Systematic Review of Literature and Meta-Analysis

OBJECTIVE

Several trials aimed at evaluating the efficacy of maternal hydration (MH) in increasing amniotic-fluid-volume (AFV) in pregnancies with isolated oligohydramnios or normohydramnos have been conducted. Unfortunately, no evidences support this intervention in routine-clinical-practice. The aim of this systematic-literature-review and meta-analysis was to collect all data regarding proposed strategies and their efficacy in relation to each clinical condition for which MH-therapy was performed with the aim of increasing amniotic-fluid (AF) and improving perinatal outcomes.

MATERIALS AND METHODS

A systematic literature search was conducted in electronic-database MEDLINE, EMBASE, ScienceDirect and the Cochrane-Library in the time interval between 1991 and 2014. Following the identification of eligible trials, we estimated the methodological quality of each study (using QADAS-2) and clustered patients according to the following outcome measures: route of administration (oral versus intravenous versus combined), total daily dose of fluids administered (<2000 versus >2000), duration of hydration therapy: (1 day, >1 day but <1 week, >1 week), type of fluid administered (isotonic versus hypotonic versus combination).

RESULTS

In isolated-oligohydramnios (IO), maternal oral hydration is more effective than intravenous hydration and hypotonic solutions superior to isotonic solutions. The improvement in AFV appears to be time-dependent rather than daily-dose dependent. Regarding normohydramnios pregnancies, all strategies seem equivalent though the administration of hypotonic-fluid appears to have a slightly greater effect than isotonic-fluid. Regarding perinatal outcomes, data is fragmentary and heterogeneous and does not allow us to define the real clinical utility of MH.

CONCLUSIONS

Available data suggests that MH may be a safe, well-tolerated and useful strategy to improve AFV especially in cases of IO. In view of the numerous obstetric situations in which a reduced AFV may pose a threat, particularly to the fetus, the possibility of increasing AFV with a simple and inexpensive practice like MH-therapy may have potential clinical applications. Considering the various strategies of maternal hydration implemented in the treatment of IO, better results were observed when treatment was based on a combination of intravenous (for a period of 1 day) and oral (for a period of at least 14 days) hypotonic fluids (≥2000ml).