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Athiel Y, Girault A, Le Ray C, Goffinet F. Association between hospitals' cesarean delivery rates for breech presentation and their success rates for external cephalic version. Eur J Obstet Gynecol Reprod Biol 2022; 270:156-163. [DOI: 10.1016/j.ejogrb.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/08/2022] [Indexed: 11/17/2022]
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Vellingiri K, Venkataraman S, Shanthappa AH, Seenappa H. Femur Shaft Fracture in Newborns: A Report of Two Cases. Cureus 2021; 13:e12504. [PMID: 33564512 PMCID: PMC7861063 DOI: 10.7759/cureus.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Birth injuries caused by trauma during the childbirth process are very rare. They are a cause of significant neonatal morbidity despite improved obstetric and perinatal care, particularly in developing countries. Our current research, consisting of two newborns with a femur fracture, aims to shed light on their treatment strategy.
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Affiliation(s)
- Kishore Vellingiri
- Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Sagar Venkataraman
- Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Arun H Shanthappa
- Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Hariprasad Seenappa
- Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Vaginal Delivery After External Cephalic Version in Patients With a Previous Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol 2020; 136:965-971. [PMID: 33030882 DOI: 10.1097/aog.0000000000004065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To estimate the rate of vaginal delivery after successful external cephalic version for breech presentation in women with compared with without a previous cesarean birth. DATA SOURCES We searched MEDLINE, Scopus, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the mode of delivery after successful external cephalic version in women with and without a previous cesarean birth. METHODS OF STUDY SELECTION Two reviewers independently identified studies, extracted data, and evaluated study quality. The rate of vaginal delivery after successful external cephalic version in women with and without a previous cesarean birth was compared, and odds ratios (ORs) with 95% CIs were estimated. TABULATION, INTEGRATION, AND RESULTS Six cohort studies and two case-control studies, reporting on 14,515 women were identified. The median point prevalence of a successful external cephalic version was 74% (interquartile range 63-81%) in women with a previous cesarean birth compared with 69% (interquartile range 64-83%) in women without a previous cesarean birth. The overall success rate of external cephalic version in women with a previous cesarean birth was similar compared with women without a previous cesarean birth (pooled OR 0.84, 95% CI 0.61-1.15). The median point prevalence of a vaginal delivery was 75% (interquartile range 61-84%) in women with a previous cesarean birth compared with 92% (interquartile range 85-95%) in women without a previous cesarean birth after a successful external cephalic version. The overall success rate of a vaginal delivery in women with a previous cesarean birth was less compared with women without a previous cesarean birth (pooled OR 0.26, 95% CI 0.14-0.50). A planned subgroup analysis on studies that included only multiparous women in the control group (parity one or greater) noted the overall success rate of external cephalic version in women with a previous cesarean birth 76% (853/1,123) was lower compared with multiparous women without a previous cesarean birth 84% (9,911/11,855) (pooled OR 0.70, 95% CI 0.54-0.89, I 37%). The overall success rate of a vaginal delivery in women with a previous cesarean birth 83% (666/806) was less compared with women without a previous cesarean birth 97% (9,449/9,746) (pooled OR 0.21, 95% CI 0.12-0.39, I 73%). CONCLUSION Women with previous cesarean birth have similar rates of successful external cephalic version when compared with women without a cesarean birth. Although the rate of vaginal delivery is lower, the majority of patients have a successful vaginal birth after cesarean. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020160145.
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Kohls F, Gebauer F, Flentje M, Brodowski L, von Kaisenberg CS, Jentschke M. Current Approach for External Cephalic Version in Germany. Geburtshilfe Frauenheilkd 2020; 80:1041-1047. [PMID: 33012836 PMCID: PMC7518935 DOI: 10.1055/a-1127-8646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 10/26/2022] Open
Abstract
Introduction Fetal breech presentation at terms occurs in 3 - 6% of pregnancies. External cephalic version can reduce the number of cesarean sections and vaginal breech deliveries. Different approaches are used to carry out external cephalic version. This study looked at the different approaches used in Germany and compared the approach used with the recommendations given in German and international guidelines. Material and Methods An anonymized online survey of 234 hospitals in Germany was carried out in 2018. In addition to asking about hospital structures, questions also focused on how external version was carried out in practice (preparations, tocolysis, anesthetics, etc.), on relative and absolute contraindications and on the success rate. Results 37.2% of the hospitals approached for the survey participated in the study. Of these, 98.8% performed external version procedures. The majority of participating hospitals were university hospitals (26.4%) and maximum care hospitals (35.6%) with an average number of more than 2000 births per year (60.9%). External cephalic version is the preferred (61.7%) obstetrical procedure to deal with breech presentation, rather than vaginal breech birth or primary cesarean section. 45.8% of respondents carry out external version procedures on an outpatient basis, and 42.1% of hospitals perform the procedure as an inpatient intervention, especially from the 37th week of gestation. Prior to performing an external version procedure, 21.6% of surveyed institutions carry out a vaginal examination to evaluate possible fixation of the fetal rump. 95.5% of institutions used fenoterol for tocolytic therapy; the majority using it for continuous tocolysis (70.2%). 1 - 3 attempts at external version (8.4%) were usually carried out by a specific senior physician. In most cases, no analgesics were administered. The reported rate of emergency cesarean sections was very low. The most common indication for emergency C-section was pathological CTG (56,7%). The assessment of relative and absolute contraindications varied, depending on the surveyed hospital. 67.5% asked patients to empty their bladders before carrying out external version, while 10.8% carried out external version when the bladder was filled. The reported success rate was more than 45%. After successful version, only 14.8% of hospitals arranged for patients to wear an abdominal binder. For 32.4%, the decision to apply an abdominal binder was taken on a case-by-case basis. Conclusion The approach used in Germany to carry out external cephalic version is based on the (expired) German guideline on breech presentation. Based on the evidence obtained, a number of individual recommendations should be re-evaluated. More recent international guidelines could be useful to update the standard procedure.
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Affiliation(s)
- Fabian Kohls
- Klinik für Frauenheilkunde und Geburtshilfe, Asklepios Harzklinik Goslar, Goslar, Germany
| | - Friederike Gebauer
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Markus Flentje
- Klinik für Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Lars Brodowski
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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McLaren R, Atallah F, Fisher N, Minkoff H. Correlation of Obesity with External Cephalic Version Success among Women with One Previous Cesarean Delivery. AJP Rep 2020; 10:e324-e329. [PMID: 33094023 PMCID: PMC7571570 DOI: 10.1055/s-0040-1715173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/13/2020] [Indexed: 10/26/2022] Open
Abstract
Objective Our aim was to assess the correlation of body mass index (BMI) with the success rate of external cephalic version (ECV) among women with one prior cesarean delivery. Study Design A cross-sectional study of pregnant women with one previous cesarean delivery who underwent ECV. The relationship between BMI and success rate of ECV was assessed. Adverse outcomes were also compared between women with an ECV attempt, and women who had a repeat cesarean delivery. Data were extracted from the U.S. Natality Database from 2014 to 2017. Pearson's correlation coefficient was performed to assess the relationship between BMI and success rate of ECV. Results There were 2,329 women with prior cesarean delivery underwent an ECV attempt. The success rate of ECV among the entire cohort was 68.3%. There was no correlation between BMI and success rate of ECV ( r = 0.024, p = 0.239). Risks of adverse maternal and neonatal outcomes were similar between the ECV attempt group and the repeat cesarean delivery group. Conclusion There was no correlation of BMI with the rate of successful ECV among women with one prior cesarean delivery. Given the similar success rates of ECV and adverse outcomes, obese women with one prior cesarean delivery should be offered ECV.
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Affiliation(s)
- Rodney McLaren
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Nelli Fisher
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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McLaren RA, Atallah F, Fisher N, Minkoff H. Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery. AJP Rep 2018; 8:e349-e354. [PMID: 30574429 PMCID: PMC6261738 DOI: 10.1055/s-0038-1676297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2018] [Indexed: 11/07/2022] Open
Abstract
Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% ( p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17-5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19-21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10-2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.
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Affiliation(s)
- Rodney A McLaren
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Fouad Atallah
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Nelli Fisher
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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Keepanasseril A, Anand K, Soundara Raghavan S. Matched cohort study of external cephalic version in women with previous cesarean delivery. Int J Gynaecol Obstet 2017; 138:79-83. [DOI: 10.1002/ijgo.12169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/19/2017] [Accepted: 04/03/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Keerthana Anand
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Subrahmanian Soundara Raghavan
- Department of Obstetrics and Gynecology; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
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Erdem Y, Akpancar S, Gemci MH. Bilateral Femoral Fracture in a newborn with Myelomeningocele at Cesarean section: A Case Report. J Orthop Case Rep 2017; 6:80-81. [PMID: 28116279 PMCID: PMC5245949 DOI: 10.13107/jocr.2250-0685.522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Femur fractures as a result of birth trauma can still occur during the C/S, in spite of recent developments of surgical and anesthetic techniques. In this study, we aimed to present a rare case of a newborn with myelomeningocele who delivered by cesarean section due to breech presentation and sustained bilateral fracture of femoral shaft. Case Presentation: A 2690 g female newborn with myelomeningocele sustained bilateral femoral shaft fractures during cesarean section. Complete healing was obtained without sequelae after 21 days ofimmobilization with long leg splints. Conclusion: Despite the development of early diagnosis and treatment modalities, there is a probability of significant birth traumas. The C/S with accurate technique and gentle obstetrical maneuvers is seemed to be the most important factor for preventing such incidents and considerable complications during abnormal delivery.
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Affiliation(s)
- Yusuf Erdem
- Department of Orthopaedics and Traumatology, Girne Military Hospital, Turkey
| | - Serkan Akpancar
- Department of Orthopaedics and Traumatology, Girne Military Hospital, Turkey
| | - M Hanifi Gemci
- Department of Orthopaedics and Traumatology, Gulhane Military Medical Academy, Ankara, Turkey
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Rodgers R, Beik N, Nassar N, Brito I, de Vries B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG 2016; 124:767-772. [DOI: 10.1111/1471-0528.14169] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- R Rodgers
- Department of Gynaecology; Royal Hospital for Women; Sydney NSW Australia
- Department of Women and Babies; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - N Beik
- Department of Women and Babies; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - N Nassar
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; Sydney NSW Australia
| | - I Brito
- Department of Gynaecology; Royal Hospital for Women; Sydney NSW Australia
| | - B de Vries
- Department of Women and Babies; Royal Prince Alfred Hospital; Sydney NSW Australia
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Burgos J, Cobos P, Rodríguez L, Osuna C, Centeno MM, Martínez-Astorquiza T, Fernández-Llebrez L. Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. BJOG 2013; 121:230-5; discussion 235. [DOI: 10.1111/1471-0528.12487] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J Burgos
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - P Cobos
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - L Rodríguez
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - C Osuna
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - MM Centeno
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - T Martínez-Astorquiza
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
| | - L Fernández-Llebrez
- Obstetrics and Gynaecology Service; BioCruces Health Research Institute; Hospital Universitario Cruces (UPV/EHU); Biscay Spain
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Menakaya U, Trivedi A. Qualitative assessment of women's experiences with ECV. Women Birth 2013; 26:e41-4. [DOI: 10.1016/j.wombi.2012.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/30/2012] [Accepted: 09/11/2012] [Indexed: 11/30/2022]
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Schmitz T. Situations cliniques particulières, maternelles ou fœtales, influençant le choix du mode d’accouchement en cas d’antécédent de césarienne. ACTA ACUST UNITED AC 2012; 41:772-81. [DOI: 10.1016/j.jgyn.2012.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leung VKT, Suen SSH, Sahota DS, Lau TK, Leung TY. External cephalic version does not increase the risk of intra-uterine death: a 17-year experience and literature review. J Matern Fetal Neonatal Med 2012; 25:1774-8. [DOI: 10.3109/14767058.2012.663828] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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[Breech presentation at term: caesarean section or vaginal delivery?]. SRP ARK CELOK LEK 2011; 139:155-60. [PMID: 21626760 DOI: 10.2298/sarh1104155d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Term breech presentation occurs in 3-4% of all deliveries. Most obstetricians are completely sure how to end delivery when the foetus is in breech presentation, by caesarean section as the only option. OBJECTIVE The main goal of the paper was to present the method of delivery for term breech presentation analyzed at the Hospital of Gynaecology and Obstetrics and Clinical Centre in Kragujevac, and parameters that influenced the decision on the method of choice to perform delivery with the foetus in breech position. METHODS During a three-year prospective study, the course and outcome of all term breech deliveries were under followup. The study involved only deliveries in breech presentation, with a trial of labour ending by vaginal delivery, while elective caesarean section due to breech presentation of the foetus was not included in the study. The following parameters were compared: body mass, newborn's first minute Apgar score and head circumference, gestational maturity, gestational age, delivery duration, maternal level of education and maternal parity. RESULTS Of total 6,470 deliveries, 653 (10.10%) were finalized by caesarean section. Of these, there were 202 (3.12%) term breech presentations, of which 72 (35.64%) women had caesarean and 130 (64.36%) vaginal delivery. A difference was detected in newborn's body mass and head circumference, delivery duration, maternal level of education and parity between pregnancies terminated surgically in comparison to vaginal delivery, while pregnancy duration, maternal age, first minute Apgar score, and most significantly, perinatal morbidity did not show any difference regardless of the method of delivery for term breech presentation. CONCLUSION With respect of all known parameters, vaginal delivery in breech presentation is also accepted.
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Prise en charge de l’accouchement des patientes ayant un antécédent de césarienne. ACTA ACUST UNITED AC 2010; 38:48-57. [DOI: 10.1016/j.gyobfe.2009.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/13/2009] [Indexed: 11/23/2022]
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Sela HY, Fiegenberg T, Ben-Meir A, Elchalal U, Ezra Y. Safety and efficacy of external cephalic version for women with a previous cesarean delivery. Eur J Obstet Gynecol Reprod Biol 2009; 142:111-4. [DOI: 10.1016/j.ejogrb.2008.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 07/09/2008] [Accepted: 08/10/2008] [Indexed: 11/29/2022]
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Kok M, Cnossen J, Gravendeel L, Van Der Post JA, Mol BW. Ultrasound factors to predict the outcome of external cephalic version: a meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:76-84. [PMID: 19115237 DOI: 10.1002/uog.6277] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To systematically review the medical literature reporting on ultrasound factors that can be predictive for the outcome of an attempt at external cephalic version (ECV). METHODS MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched. Studies reporting on potential ultrasound prognosticators and ECV success rates that allowed construction of a 2x2 table were selected. RESULTS We selected 37 primary articles reporting on 7709 women. Posterior placental location (odds ratio (OR), 1.9; 95% CI, 1.5-2.4), complete breech position (OR, 2.3; 95% CI, 1.9-2.8) and an amniotic fluid index>10 (OR, 1.8; 95% CI, 1.5-2.1) were predictors of successful ECV. CONCLUSION Success of an ECV attempt is associated with ultrasound parameters such as fetal position, amniotic fluid and placental location. This knowledge can be used to develop a prognostic model to predict successful ECV.
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Affiliation(s)
- M Kok
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Kok M, Cnossen J, Gravendeel L, van der Post J, Opmeer B, Mol BW. Clinical factors to predict the outcome of external cephalic version: a metaanalysis. Am J Obstet Gynecol 2008; 199:630.e1-7; discussion e1-5. [PMID: 18456227 DOI: 10.1016/j.ajog.2008.03.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 11/11/2007] [Accepted: 03/03/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study was to systematically review the medical literature reporting on potential clinical prognosticators for the outcome of external cephalic version (ECV). STUDY DESIGN Medline, EMBASE, and Cochrane Central Register of Controlled Trials were searched. Studies reporting on potential clinical prognosticators and ECV success rates that allowed construction of a 2 x 2 table were selected. RESULTS We detected 53 primary articles reporting on 10,149 women. Multiparity (P >/= 1.00; odds ratio [OR], 2.5; 95% confidence interval [CI], 2.3-2.8), nonengagement of the breech (OR, 9.4; 95% CI, 6.3-14), a relaxed uterus (OR, 18; 95% CI, 12-29), a palpable fetal head (OR, 6.3; 95% CI, 4.3-9.2), and maternal weight less than 65 kg (OR, 1.8; 95% CI, 1.2-2.6) were predictors for successful external cephalic version. CONCLUSION Success of an ECV attempt is associated with clinical factors. This should be taken into account in the counseling of women prior to an ECV attempt.
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Affiliation(s)
- Marjolein Kok
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
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WISE MR, SADLER L, ANSELL D. Successful but limited use of external cephalic version in Auckland. Aust N Z J Obstet Gynaecol 2008; 48:467-72. [DOI: 10.1111/j.1479-828x.2008.00889.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cebesoy FB, Cebesoy O, Incebiyik A. Bilateral femur fracture in a newborn: an extreme complication of cesarean delivery. Arch Gynecol Obstet 2008; 279:73-4. [DOI: 10.1007/s00404-008-0639-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 03/18/2008] [Indexed: 11/28/2022]
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Rijnders M, Herschderfer K, Prins M, van Baaren R, van Veelen AJ, Schönbeck Y, Buitendijk S. A retrospective study of the success, safety and effectiveness of external cephalic version without tocolysis in a specialised midwifery centre in the Netherlands. Midwifery 2008; 24:38-45. [PMID: 17196716 DOI: 10.1016/j.midw.2006.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 07/05/2006] [Accepted: 07/17/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND to evaluate the effectiveness of external cephalic version (ECV) without tocolysis or epidural analgesia, the complications associated with the procedure and the association between the number of ECV attempts and cephalic presentation at birth and caesarean section. METHODS retrospective cohort study of all (n=924) ECVs carried out between 1996 and 2000 in a specialised midwifery centre in the Netherlands. After bivariate analysis, those variables with a p value under 0.05 were considered statistically significant and were tested in a logistic regression model using backward stepwise selection. Analyses were carried out separately for first ECV attempts and second ECV attempts. FINDINGS in total, 958 ECVs were analysed, 889 first attempts and 69 repeat attempts. Seventy per cent of all first ECVs were carried out before 37 weeks, but half of those were carried out between 36 and 37 weeks. The success rate for first ECV was 41% and for the second ECV 29%. Bivariate analysis showed that the success of the first ECV was positively influenced by parity, non-Dutch origin, higher birth weight, higher age and longer duration of pregnancy. After logistic regression, parity (odds ratio [OR] 2.8, 95% CI 2.1 to 3.7), non-Dutch origin (OR 1.8, 95% CI 1.2 to 2.8) and birth weight (OR 1.7, 95% CI 1.4 to 2.0) remained factors that independently influenced the success of ECV. The odds ratio for duration of pregnancy at first ECV was borderline significant: OR 1.2 (1.0 to 1.4). After an unsuccessful first ECV, only 13% of the women received a second ECV. The prevalence of cephalic presentation at birth increased with 3% after a second ECV. Three cases of complications were reported during or very shortly after the first ECV, and these did not result in serious complications. No complications were reported after a second ECV. CONCLUSION ECV without tocolysis is a safe procedure for pregnant women and their babies. Repeat ECV increases the number of cephalic presentations at birth and should be considered after an unsuccessful ECV.
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Affiliation(s)
- Marlies Rijnders
- TNO Quality of Life, Prevention and Physical Activity, Child Health Division, P.O. Box 2215, 2301 CE Leiden, The Netherlands.
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El-Toukhy T, Ramadan G, Maidman D, Hanna L, Waterstone M. Impact of parity on obstetric and neonatal outcome of external cephalic version. J OBSTET GYNAECOL 2008; 27:580-4. [PMID: 17896255 DOI: 10.1080/01443610701469586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study sought to investigate the impact of parity on the outcome of external cephalic version (ECV) over a 3-year period. In the study, 163 women with singleton uncomplicated breech pregnancy at term were offered ECV and 103 (63%) underwent the procedure. In 42 women, ECV was successful and 74% had a vaginal vertex delivery; whereas 61 women had a failed ECV and none had a vaginal vertex delivery. The probability of vaginal vertex delivery after ECV increased five-fold in nulliparous women (OR 5.2, 95% CI 1 - 42.8) and four-fold (OR 3.8, 95% CI 1.3 - 11.5) in multiparous women. After successful ECV, 50% of nulliparous women and 88.5% of multiparous women had a vaginal vertex delivery (p = 0.006). Neonatal outcome was favourable in all patients. We conclude that parity has little impact on efficacy of ECV, but significantly influences the overall chance of vaginal vertex delivery in women with an uncomplicated breech presentation at term.
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Affiliation(s)
- T El-Toukhy
- Department of Obstetrics and Gynaecology, Queen Mary's Hospital NHS Trust, Sidcup, UK.
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Factors Associated With a Successful External Cephalic Version in the Esarly ECV Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:23-28. [DOI: 10.1016/s1701-2163(16)32709-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
BACKGROUND Femoral fractures due to birth trauma are extremely rare. External cephalic version is considered a relatively safe alternative when dealing with breech presentation, but it can be associated with complications. CASE This patient underwent elective cephalic version for breech presentation at 36 weeks of gestation. Due to concerns of fetal distress after the version, a cesarean delivery was performed. The newborn had a bruised leg at delivery, and X-ray studies confirmed a distal femoral corner fracture. CONCLUSION This case demonstrates another risk of external cephalic version. Physicians and patients should be aware of this potential complication.
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Affiliation(s)
- Steven Papp
- Department of Orthopedics, Queen's University, Kingston, Ontario, Canada
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Collaris RJ, Oei SG. External cephalic version: a safe procedure? A systematic review of version-related risks. Acta Obstet Gynecol Scand 2004; 83:511-8. [PMID: 15144330 DOI: 10.1111/j.0001-6349.2004.00347.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Term Breech Trial has considerably increased the number of cesareans. External cephalic version (ECV) might be an effective method of lowering the rate of cesareans; its efficacy has been well established. However, although in the absence of anesthesia the risks are thought to be low, most studies have used populations too small to allow definite conclusions on version-related risks. METHODS In an attempt to make an inventory of these risks, we have systematically analyzed 44 studies, covering a total of 7377 patients from 1990 to 2002. The studies used were derived from a Medline and Embase search. RESULTS The most frequently reported complications were transient abnormal cardiotocography (CTG) patterns (5.7%). Persisting pathological CTG readings (0.37%) and vaginal bleeding occur rarely (0.47%). The incidence of placental abruption was even lower, at 0.12%. Fetomaternal transfusion was absent in five out of seven studies, with a mean incidence of 3.7%. Emergency cesareans were performed in 0.43% of all versions. Perinatal mortality was 0.16%. CONCLUSIONS External cephalic version seems to be a safe procedure.
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Affiliation(s)
- Ronald J Collaris
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
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Håheim LL, Albrechtsen S, Berge LN, Børdahl PE, Egeland T, Henriksen T, Øian P. Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team. Acta Obstet Gynecol Scand 2004. [DOI: 10.1111/j.0001-6349.2004.00349.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shankar M, Gough GW, Chakravarti S, Vellacott ID. Massive Feto-Maternal Haemorrhage with Good Perinatal Outcome following Failed External Cephalic Version. Fetal Diagn Ther 2003; 19:68-71. [PMID: 14646421 DOI: 10.1159/000074263] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2002] [Accepted: 01/17/2003] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To reinforce the risk of feto-maternal haemorrhage associated with external cephalic version for breech presentation. METHOD A single case report with a literature review. RESULTS Our case report was associated with the largest feto-maternal haemorrhage following external cephalic version reported so far. The perinatal outcome in this case was favourable despite a significant amount of fetal haemorrhage. The literature review did include cases with unfavourable outcomes. No reliable method of monitoring fetuses with feto-maternal haemorrhage has been reported, although middle cerebral artery Doppler studies appear to show promise. CONCLUSION External cephalic version is useful in the management of breech presentations at term, but it is not without risks and clinicians need to be aware of this.
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Affiliation(s)
- M Shankar
- Lincoln County Hospital, Lincoln, UK.
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Pistolese RA. The Webster Technique: a chiropractic technique with obstetric implications. J Manipulative Physiol Ther 2002; 25:E1-9. [PMID: 12183701 DOI: 10.1067/mmt.2002.126127] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To survey members of the International Chiropractic Pediatric Association (ICPA); regarding the use of the Webster Technique for managing the musculoskeletal causes of intrauterine constraint, which may necessitate cesarean section. METHODS Surveys were mailed to 1047 US and Canadian members of the ICPA. RESULTS One hundred eighty-seven surveys were returned from 1047 ICPA members, constituting a return rate of 17.86%. Seventy-five responses did not meet the study inclusion criteria and were excluded; 112 surveys (11%) provided the data. Of these 112 surveys, 102 (92%) resulted in resolution of the breech presentation, while 10 (9%) remained unresolved. CONCLUSION The surveyed doctors reported a high rate of success (82%) in relieving the musculoskeletal causes of intrauterine constraint using the Webster Technique. Although the sample size was small, the results suggest that it may be beneficial to perform the Webster Technique in month 8 of pregnancy, when breech presentation is unlikely to spontaneously convert to cephalic presentation and when external cephalic version is not an effective technique. When successful, the Webster Technique avoids the costs and/or risks of external cephalic version, cesarean section, or vaginal trial of breech.In view of these findings, the Webster Technique deserves serious consideration in the health care management of expectant mothers exhibiting adverse fetal presentation.
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