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Evaluación del conocimiento de la versión cefálica externa y de las preferencias sobre el manejo de la presentación podálica a término entre mujeres en edad fértil. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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López-Pérez R, Lorente-Fernández M, Velasco-Martínez M, Martínez-Cendán JP. Prediction model of success for external cephalic version. Complications and perinatal outcomes after a successful version. J Obstet Gynaecol Res 2020; 46:2002-2009. [PMID: 32779362 DOI: 10.1111/jog.14385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022]
Abstract
AIM External cephalic version (ECV) is an effective and safe technique for avoiding breech presentation at birth. However, it continues rejected by many women. The aim of this study is to develop a predictive model of success of external cephalic version, determine the safety of the technique and perinatal outcomes after successful version. METHODS Data from 317 versions performed over a 6-year period were collected. Different clinical and ultrasound variables, complications, vaginal delivery after successful version and perinatal outcomes were analyzed. RESULTS The overall success rate was 72% (229 of 317 versions). The variables most related to success were parity, placental location, amniotic fluid volume, fetal sex, fetal head palpation and descent of the presenting part. A model for calculating the probability of success was developed in which to input parity, placentation and amniotic fluid data. The model correctly classified 98.8% of successful technique and 74% of all women. Complications were very few and mostly mild. Of women who had success, 77% (163 of 212) had a vaginal birth. No differences between neonatal outcomes were found. CONCLUSION External cephalic version is a successful, safe technique with a high rate of subsequent vaginal delivery. A success prediction model based on some very easily obtained variables can personalize the probability of success.
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Affiliation(s)
- Rocío López-Pérez
- Health Sciences PhD Program, Catholic University of Murcia UCAM, Guadalupe, Murcia, Spain
| | - Mónica Lorente-Fernández
- Department of Obstetrics and Gynecology, University General Hospital Santa Lucía, Cartagena, Spain
| | - María Velasco-Martínez
- Department of Obstetrics and Gynecology, University General Hospital Santa Lucía, Cartagena, Spain
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Anand K, Keepanasseril A, Amala R, Nair NS. Development and validation of a clinical score to predict the probability of successful procedure in women undergoing external cephalic version. J Matern Fetal Neonatal Med 2019; 34:2925-2931. [PMID: 31590593 DOI: 10.1080/14767058.2019.1674803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION External Cephalic Version (ECV) reduces breech presentation at term and thus contribute to the reduction of cesarean section. This study was done to determine the factors associated with the successful ECV in women with breech presentation after 36 weeks' gestation and also to develop and validate a clinical score which could be utilized for individual patient counseling in future. METHODS This was a retrospective cohort study conducted in a tertiary care center and teaching hospital in south India. Prospectively collected data from the register maintained for all ECVs performed on pregnant women with breech presentation at or more than 36 weeks' gestation. Clinical and ultrasound parameters at the time of performing the procedure were used in the analysis. Multiple logistic regression with a stepwise backward selection procedure was used selecting potential variable to construct the model and internal validation was done with bootstrapping. Primary outcome was successful ECV defined as cephalic presentation at the end of the procedure. RESULTS Among 611 women who underwent ECV, it was successful in 70.4%. In the multiple logistic regression model, multiparity (OR4.48), AFI ≥ 7 (OR = 3.06), type of breech, posterior placental location (OR = 1.57), sacro-anterior position of breech (OR = 2.83), normal uterine tone (OR = 1.82) and fetal pole not engaged (OR = 2.82) were found to be predictive of successful ECV with good discrimination (AUC = 0.782) and acceptable calibration. Combining these factors from the model a predictive score (score 0-13) is proposed for clinical utility. CONCLUSIONS Combining clinical and ultrasound parameters into a predictive score, which is simple and effective, could be utilized in the clinical practice, once validated externally.
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Affiliation(s)
- Keerthana Anand
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Pondicherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Pondicherry, India
| | - R Amala
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - N Sreekumaran Nair
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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Hutton EK, Simioni JC, Thabane L. Predictors of success of external cephalic version and cephalic presentation at birth among 1253 women with non-cephalic presentation using logistic regression and classification tree analyses. Acta Obstet Gynecol Scand 2017; 96:1012-1020. [DOI: 10.1111/aogs.13161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Eileen K. Hutton
- Department of Obstetrics and Gynecology; McMaster University; Hamilton Ontario Canada
| | - Julia C. Simioni
- Midwifery Education Program; McMaster University; Hamilton Ontario Canada
| | - Lehana Thabane
- Department of Health Research Methods; Evidence, and Impact (HEI); McMaster University; Hamilton Ontario Canada
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Velzel J, de Hundt M, Mulder FM, Molkenboer JF, Van der Post JA, Mol BW, Kok M. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 195:160-167. [DOI: 10.1016/j.ejogrb.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/29/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Khaw K, Lee S, Ngan Kee W, Law L, Lau T, Ng F, Leung T. Randomized trial of anaesthetic interventions in external cephalic version for breech presentation. Br J Anaesth 2015; 114:944-50. [DOI: 10.1093/bja/aev107] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 11/13/2022] Open
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Vlemmix F, Rosman AN, te Hoven S, van de Berg S, Fleuren MAH, Rijnders ME, Beuckens A, Opmeer BC, Mol BWJ, Kok M. Implementation of external cephalic version in the Netherlands: a retrospective cohort study. Birth 2014; 41:323-9. [PMID: 25288341 DOI: 10.1111/birt.12133] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND External cephalic version (ECV) reduces the rate of elective cesarean sections as a result of breech presentation. Several studies have shown that not all eligible women undergo an ECV attempt. The aim of this study was to evaluate the implementation of ECV in the Netherlands and to explain variation in implementation rates with hospital characteristics and individual factors. METHODS We invited 40 hospitals to participate in this retrospective cohort study. We reviewed hospital charts for all singleton breech deliveries from 36 weeks' gestation and onwards between January 2008 and December 2009. We documented whether an ECV attempt was performed, reasons for not performing an attempt, mode of delivery, and hospital characteristics. RESULTS We included 4,770 women from 36 hospitals. ECV was performed in 2,443 women (62.2% of eligible women, range 8.2-83.6% in different hospitals). Implementation rates were higher in teaching hospitals, hospitals with special office hours for ECV, larger obstetric units, and hospitals located in larger cities. Suboptimal implementation was mainly caused by health care providers who did not offer ECV. CONCLUSION ECV implementation rates vary widely among hospitals. Suboptimal implementation is mostly caused by the care provider not offering the treatment and secondly due to women not opting for the offered attempt. A prerequisite for designing a proper implementation strategy is a detailed understanding of the exact reasons for not offering and not opting for ECV.
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Affiliation(s)
- Floortje Vlemmix
- Department of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, the Netherlands
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Toivonen E, Palomäki O, Huhtala H, Uotila J. Maternal experiences of vaginal breech delivery. Birth 2014; 41:316-22. [PMID: 24935907 DOI: 10.1111/birt.12119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal mode of breech birth remains controversial. In Finland, a trial of vaginal delivery is possible if strict selection criteria are met. As clinical practice in managing vaginal breech birth differs from that in normal delivery, the birth experience may also be different. This cohort study compares the childbirth experience between term breech and vertex deliveries. METHODS Intended vaginal term breech births from 2008 to October 2012 were included, and for every breech delivery, a vertex control was selected. The proportions of deliveries ending in a cesarean section and of mothers who had given birth vaginally before were equal in both groups. Three hundred eight mothers were sent the childbirth experience questionnaire and 170 returned it. RESULTS The birth experience does not differ between breech and vertex births, except for aspects with respect to the choice of birthing position. Indications of an even more positive experience were observed in the breech group, with the exception of the choice of analgesia, but these were not statistically significant. Primiparity, emergency cesarean section, infant birth trauma and prolonged hospital stay were identified as risk factors for a negative birth experience. CONCLUSION The birth experience of vaginal breech birth seems to be at least as positive as the vaginal vertex birth experience.
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Affiliation(s)
- Elli Toivonen
- School of Medicine, University of Tampere, Tampere, Finland
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Say R, Thomson R, Robson S, Exley C. A qualitative interview study exploring pregnant women's and health professionals' attitudes to external cephalic version. BMC Pregnancy Childbirth 2013; 13:4. [PMID: 23324533 PMCID: PMC3567941 DOI: 10.1186/1471-2393-13-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/15/2012] [Indexed: 01/22/2023] Open
Abstract
Background Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. Methods We carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Results Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Conclusions Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence-based information about ECV and lay beliefs. To address these challenges a number of approaches will be required.
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Affiliation(s)
- Rebecca Say
- Institute of Health and Society, Baddiley - Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK.
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ROSMAN AGEETHN, GUIJT ALINE, VLEMMIX FLOORTJE, RIJNDERS MARLIES, MOL BENWJ, KOK MARJOLEIN. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand 2012; 92:137-42. [DOI: 10.1111/aogs.12011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Guerra S, Lopez-Picado A, Muñoz H, Marín J, Lete I, Echevarria O. Versión cefálica externa en presentación de nalgas: una técnica ancestral muy actual. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Suen SSH, Khaw KS, Wa Law L, Singh Sahota D, Yee Lee SW, Lau TK, Yeung Leung T. The force applied to successfully turn a foetus during reattempts of external cephalic version is substantially reduced when performed under spinal analgesia. J Matern Fetal Neonatal Med 2011; 25:719-22. [DOI: 10.3109/14767058.2011.589931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rijnders M, Offerhaus P, van Dommelen P, Wiegers T, Buitendijk S. Prevalence, outcome, and women's experiences of external cephalic version in a low-risk population. Birth 2010; 37:124-33. [PMID: 20557535 DOI: 10.1111/j.1523-536x.2010.00392.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Until recently, external cephalic version to prevent breech presentation at birth was not widely accepted. The objective of our study was to assess the prevalence, outcomes, and women's experiences of external cephalic version to improve the implementation of the procedure in the Netherlands. METHODS A prospective cohort study was conducted of 167 women under the care of a midwife with confirmed breech presentation at a gestational age of 33 completed weeks or more. RESULTS Between June 2007 and January 2008, 167 women with a confirmed breech presentation were offered an external cephalic version. Of this group, 123 women (73.7%, 95% CI: 65.5-80.5) subsequently received the version. These women had about a ninefold increased probability of a cephalic presentation at birth compared with women who did not undergo a version (relative risk [RR]: 8.8, 95% CI: 2.2-34.8). The chance of a vaginal birth after an external cephalic version was almost threefold (RR: 2.7, 95% CI: 1.5-5.0). The success rate was 39 percent, although considerable differences existed associated with region and parity. Ninety-four percent of women with a successful version rated it as a good experience compared with 71 percent of women who had a failed version (p = 0.015). Significant pain during the version was experienced by 34 percent of women, of whom 18 percent also experienced fear during the version, compared with no women who reported little or no pain (p = 0.006). Women who reported significant pain or fear during the version experienced the version more negatively (OR: 6.0, 95% CI: 3.3-12.2 and OR: 2.7, 95% CI: 1.1-6.0, respectively). CONCLUSIONS One in every four women with a breech presentation in independent midwifery care did not receive an external cephalic version. Of the women who received a version one third experienced significant pain during the procedure. Considerable regional variation in success rate existed.
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Affiliation(s)
- Marlies Rijnders
- TNO Quality of Life, PO Box 2215, 2301 CE Leiden, The Netherlands
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Vlemmix F, Rosman AN, Fleuren MAH, Rijnders MEB, Beuckens A, Haak MC, Akerboom BMC, Bais JMJ, Kuppens SMI, Papatsonis DN, Opmeer BC, van der Post JAM, Mol BWJ, Kok M. Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version. BMC Pregnancy Childbirth 2010; 10:20. [PMID: 20459717 PMCID: PMC2874762 DOI: 10.1186/1471-2393-10-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 05/10/2010] [Indexed: 11/23/2022] Open
Abstract
Background Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less. We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. Method/design The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV. The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. Discussion This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Trial Registration Dutch Trial Register (NTR): 1878
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Affiliation(s)
- Floortje Vlemmix
- Department of Gynaecology and Obstetrics, Academic Medical Centre, Amsterdam, the Netherlands.
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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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Founds SA. Women's and providers’ experiences of breech presentation in Jamaica: A qualitative study. Int J Nurs Stud 2007; 44:1391-9. [PMID: 16979172 DOI: 10.1016/j.ijnurstu.2006.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 07/11/2006] [Accepted: 07/13/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Most research on breech relates to medical management of the malpresentation. Little is known about women's or providers' experiences of breech, an obstetrical complication. OBJECTIVES This study aims to increase the understanding of women's and providers' experiences of breech presentation and to understand the effects of context on these experiences. METHODS A qualitative descriptive research was conducted in a rural health district of Jamaica. Nine postpartum women who birthed singleton live born breech infants in the past year and five experienced obstetric care providers consented to participate. Content analysis was conducted with data from one-time interviews, observations, and hand searches of maternity ward delivery logs. Member checking was conducted with successive participants and Jamaican health care providers. RESULTS Findings included realizing the baby was breech, interpreting what breech meant, reacting to breech presentation, and identifying the impact of breech. Rates of breech births were less than 1%. CONCLUSIONS Symbolic interaction can guide nursing and midwifery education, practice and research of breech presentation. Nurses and midwives can identify and teach women and their significant others about breech and its risks.
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Affiliation(s)
- Sandra A Founds
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA.
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Abstract
Participant-centered clinical research is essential for client-centered evidence-based health care in pregnancy. Breech malpresentation can obstruct labor, contributing to maternal mortality. This qualitative study of women's and providers' experience of breech led to five categories of themes related to participant-centered research: participation in this study, factors impeding women's participation, factors impeding clinical research, development of a participant-centered intervention, and improvement of a pregnancy research infrastructure. The findings contribute to understanding research participation during pregnancy. Gauging research protocols to fit questions of concern, women's and providers' experiences, and practice settings supports participant-centered pregnancy risk reduction research that could decrease maternal mortality.
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Affiliation(s)
- Sandra A Founds
- University of Pittsburgh, School of Nursing. Pittsburgh, Pennsylvania 15261, USA.
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Siassakos D, Anderson H, Panter K. Breech presentation: an audit project as means of pursuing clinical excellence. J OBSTET GYNAECOL 2006; 25:642-7. [PMID: 16263535 DOI: 10.1080/01443610500278246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinical audit is an effective quality improvement process to evaluate important clinical issues. Breech presentation is such an issue due to its contribution to the rising caesarean section (CS) rate. We set out to assess the management of breech presentation using, as standards, the delivery suite protocol and national guidelines. Our first audit revealed a low success rate of external cephalic version (ECV) and deficient documentation of written consent for ECV, other aspects of care being satisfactory. The results were presented to a multidisciplinary meeting and disseminated to relevant stakeholders. A re-audit was then performed. It confirmed significant improvement in the documentation of consent for ECV. It also revealed a good detection rate of breech, optimal offer rate of ECV and good neonatal outcome. However, uptake of ECV as well as the success rate could both be improved so as to reduce the CS rate for breech presentation. We discuss options for improving the uptake and success rate for ECV.
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Affiliation(s)
- D Siassakos
- Kingston Hospital NHS Trust, Kingston-upon-Thames, Surrey, UK.
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Abstract
BACKGROUND Maternal posture is commonly recommended to promote cephalic version of breech presentation during pregnancy, but the few studies conducted to examine the efficacy of this obstetric practice are inconclusive. The purpose of this systematic review was to evaluate the research evidence base for postural management of breech presentation. METHODS This review critically examined the research on maternal posture for breech presentation using guidelines from the third United States Preventive Services Task Force. Database searches were conducted of Ovid Medline, Cumulative Index of Nursing and Allied Health Literature, PubMed, and Cochrane Database of Systematic Reviews, using the keywords "pregnancy," "maternal posture," "maternal position," "postural management," "breech," "presentation." Hand searches were conducted on reference citations from databases, and all research articles, commentaries, and reports of clinical cases were included. RESULTS Conceptual and methodological issues in the individual studies posed threats to internal validity in each study. Interpretation of the nonsignificant results in the research reports is debatable because the randomized controlled trials were underpowered, and flaws in each study challenged validity of the results. Meta-analysis of previous findings may be inappropriate. CONCLUSIONS Further research based on explicit theory and improved methods, including sufficient sample size, is needed to determine whether maternal posture promotes cephalic version for pregnant women with breech presentation.
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Affiliation(s)
- Sandra A Founds
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Raynes-Greenow CH, Roberts CL, Barratt A, Brodrick B, Peat B. Pregnant women's preferences and knowledge of term breech management, in an Australian setting. Midwifery 2004; 20:181-7. [PMID: 15177862 DOI: 10.1016/j.midw.2003.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2003] [Revised: 05/29/2003] [Accepted: 09/24/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess women's familiarity with breech presentation and external cephalic version (ECV), and to identify women's preferences and attitudes regarding breech management. DESIGN Cross-sectional survey. SETTING King George V (KGV) Memorial Hospital for Mothers and Babies, Sydney, Australia, a major metropolitan teaching hospital. POPULATION 174 pregnant women (20-38 weeks gestation) attending KGV for antenatal care in 2001. METHODS Data were obtained from a self-administered questionnaire that was distributed through the antenatal clinics. MAIN OUTCOME MEASURES Women's familiarity of breech presentation and ECV, women's attitude towards ECV, decision to attempt ECV, and with whom participants would like to make a decision regarding ECV. FINDINGS Of the 174 respondents, 85% could correctly identify breech presentation, and 66% had heard of ECV. For 87% this information was from books, and family/friends, and not their midwife/doctor. Equal numbers of women responded that they would or would not choose ECV (39%), and the remaining 22% were uncertain. Factors influencing their decision included concerns about the safety for the baby, ECV not guaranteeing vaginal birth despite successful version, and ECV not being effective enough. Seventy-two per cent wanted to make the decision to attempt ECV together with their doctor. CONCLUSION Although the majority of the women had a preference for vaginal birth, their knowledge of ECV appeared insufficient to enable them to make informed decisions about attempting ECV. These findings suggest that care-providers should offer women information on ECV, in a shared-decision-making environment.
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Affiliation(s)
- Camille H Raynes-Greenow
- Centre for Perinatal Health Services Research, Screening and Test Evaluation Program, School of Public Health, University of Sydney, Australia.
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Leung TY, Sahota DS, Fok WY, Chan LW, Lau TK. Quantification of contact surface pressure exerted during external cephalic version. Acta Obstet Gynecol Scand 2003; 82:1017-22. [PMID: 14616275 DOI: 10.1034/j.1600-0412.2003.00269.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The amount of force exerted on the uterus and fetus during external cephalic version (ECV) may be associated with fetal effects or complications. We have designed an instrument to quantify the contact pressure exerted during the performance of ECV, as an indirect measurement of the applied force. METHODS We have designed a pair of custom-made gloves. Each glove contains 16 piezo-resistive sensors positioned on the palmer surface of the fingers, thenar and hypothenar areas. Pressure readings were recorded simultaneously from all sensors every 0.22 s during each version procedure. Each recording was analyzed with a computer program written according to specified algorithms to ascertain the number of attempts in a version operation, and the duration and pressure changes of each attempt during the operation. RESULTS Ten subjects having a singleton breech presentation at term underwent an operation of ECV. The number of attempts of version in each operation ranged from one to four. The median pressure-time integral and the duration of an attempt were 19,227 mmHg s (range 5089-42,597 mmHg s) and 42.5 s (range 11.9-80.3 s), respectively. The median pressure-time integral of a whole version operation was 38,110 mmHg s (range 5089-107,511 mmHg s). Subjects with a failed version operation received a higher pressure-time integral (p < 0.05). The number of attempts of each operation was accurately identified by the program. CONCLUSIONS Measurement of force applied during ECV can be quantified indirectly in terms of contact surface pressure. The indirect measurement of the applied force may further improve the safety of this procedure by preventing excessive use of force by the operator.
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Affiliation(s)
- Tak Yeung Leung
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China SAR.
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Yogev Y, Horowitz E, Ben-Haroush A, Chen R, Kaplan B. Changing attitudes toward mode of delivery and external cephalic version in breech presentations. Int J Gynaecol Obstet 2002; 79:221-4. [PMID: 12445986 DOI: 10.1016/s0020-7292(02)00274-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the attitude of gravid women in breech presentation towards external cephalic version (ECV) and mode of delivery between 1995 and 2001. METHODS A questionnaire on ECV and mode of delivery was distributed to women in the third trimester of pregnancy with breech presentation, attending our departmental clinic for a routine check-up once in 1995 and again in 2001 in order to analyze changing attitudes. RESULTS One hundred fifty-four women completed the questionnaire in 1995 and 127 in 2001. There were no statistically significant differences between the groups in age, gestational age, gravidity, parity, or level of education. In 1995, more than half the women (52.7%) had heard of ECV and 53.8% were willing to consider it, whereas in 2001, 73.2% had heard of it but only 23.9% were willing to consider it. In both groups, the women who were familiar with ECV were more likely to work outside of the home, have a higher level of educated than the women who were not. The women who were willing to try ECV were more likely not to work outside of the home, to consider their pregnancy low risk, and to opt for vaginal delivery (vs. cesarean section) if ECV did not succeed. The percentage of women who would choose planned cesarean section if the presentation remained breech was significantly higher in 2001 (97%) than in 1995 (64.7%). CONCLUSIONS Attitudes toward breech delivery have changed since 1995. More women are aware of the option of ECV but are less inclined to consider it. Planned cesarean section for breech presentation is the overwhelming choice of women in general, with a significant increase in 2001 compared with 1995.
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Affiliation(s)
- Y Yogev
- Department of Obstetrics and Gynecology, Women's Comprehensive Health Center, Rabin Medical Center, Petah Tikva, Israel
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Abstract
Our objective was to determine obstetricians' personal choices in relation to modes of delivery and long-term outcomes. A structured confidential survey was mailed out to all Australian and New Zealand Fellows, Members, and Australian Trainees with The Australian and New Zealand Journal of Obstetrics and Gynaecology November 1999 edition. The response rate overall was 26% (478). Eleven per cent (54) chose to have an elective Caesarean section (ECS) in the absence of any clinical indication. The most common reason for this was fear of faecal and urinary incontinence (82%). Two-thirds (318) were agreeable to patients requesting an ECS in this same setting. Twenty-six per cent said they would choose ECS if the estimated fetal weight (EFW) was > 4000 g which more than doubled to 55% (261) if EFW was > 4500 g. Ventouse delivery was the most popular method of assisted rotational delivery at 45% (214) followed closely by Keilland's forceps at 40% (189). Caesarean section (CS) was chosen by only 14% (65) in this scenario. ECS was the preferred method for breech delivery at 38% (181) followed by trial of breech delivery at 23% (109). Thirty-two per cent (154) of respondents would attempt external cephalic version prior to deciding mode of delivery. Respondents felt the most important factors for postnatal incontinence included: antenatal incontinence (64%), length of second stage > one hour (50%), forceps delivery (46%), and EFW > 4000 g at term (44%).
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Affiliation(s)
- R Land
- Kirwan Hospital for Women, Townsville, Queensland, Australia
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