External cephalic version of breech fetus after 36 weeks of gestation –⁠ evaluation of efectiveness and complications

Czech version

Authors: Lukáš Hruban ¹; Petr Janků ¹; K. Jordánová ¹; Romana Gerychová ¹; Martin Huser ¹; P. Ventruba ¹; A. Roztočil ²
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba DrSc., MBA ¹; Gynekologicko-porodnické oddělení, Nemocnice Jihlava, primář prof. MUDr. A. Roztočil, CSc. ²
Published in: Ceska Gynekol 2017; 82(6): 443-449

Overview

Objective:
Evaluation of success rate and the safety of external cephalic version after 36 weeks of gestation.

Design:
Retrospective analysis.

Setting:
Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno.

Methods:
A retrospective analysis of external cephalic version attempts performed on a group of 638 singleton breech pregnancies after 36 weeks gestation in the years 2003–2016 at the Department of Gynecology and Obstetrics, Masaryk University, Brno. The effectiveness, number and type of complications, mode of delivery and perinatal result were observed.

Results:
The effectiveness of external cephalic version from breech to head presentation was 47.8% (305 cases). After a successful external cephalic version 238 patients (78.0%) gave birth vaginally. After unsuccessful cephalic version 130 patients (39.0%) gave birth vaginally. The number of serious complications did not exceed 0,9% and did not affect perinatal outcomes. External cephalic version-related emergency cesarean deliveries occurred in 6 cases (2 placental abruption, 4 abnormal cardiotocography). The fetal outcome was good in all these cases. The death of the fetus in connection with the external version has not occurred in our file. Spontaneous discharge of amniotic fluid within 24 hours after procedure occurred in 5 cases (0.8%). The spontaneous onset of labor within 24 hours of procedure occurred in 5 cases (0.8%). The pH value of a. umbilicalis < 7.00 occurred in 2 cases in the group with a successful external version and in the group with unsuccessful external version in 9 cases. The Apgar score in the 5th minute < 5 was both in the successful and unsuccessful group in 1 case.

Conclusion:
The external cephalic version of the fetus in the case of breech presentation after the 36th week of pregnancy is an effective and safe alternative for women who have a fear of the vaginal breech delivery. Performing the external cephalic version can reduce the rate of elective caesarean sections due to breech presentation at term.

Keywords:
external cephalic version, breech presentation, caesarean section

Sources

1. ACOG Committee Opinion No. 265, Mode of term singleton breech delivery. Obstet Gynecol, 2006, 108, p. 235–237.

2. Baskett, TF., Calder, AA., Arulkumaran, S. Munro Kerr´s operative obstetrics. Saunders Elsevier, twelfth ed., 2014.

3. Beuckens, A., Rijnders, M., Verburgt-Doeleman, GHM., et al. An observational study of the success and complications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwifes. BJOG, 2016, 123, p. 415–423.

4. Binder, T., Unzeitig, V., Velebil, P. Vedení prenatální péče a porodu donošeného plodu v poloze koncem pánevním –⁠ doporučený postup, Čes Gynek, 2013, 78, s. 21–22.

5. Burgos, J., Pijoan, JI., Osuna, C., et al. Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial. Acta Obstet Gynecol Scand, 2016, 95, p. 547–554.

6. Burgos, J., Cobos, P., Osuba, C., et al. Nitrous oxide for analgesia in external cephalic version at term: prospective comparative study. J Perinatal Med, 2013, 41(6), p. 719–723.

7. Cluver, C., Gyte, GM., Sinclair, M., et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev., 2015, 9(2), CD000184.

8. Doležal, A. Technika porodnických operací. Praha: Grada Publishing, 1. vyd., 1998.

9. Ebner, F., Friedl, T., Leinert, E., et al. Predictors for a successful external cephalic version: a single centre experience. Arch Gynaecol Obstet, 2016, 193, p. 749–755.

10. Fok, WY., Chan, LW., Leung, TY., et al. Maternal experience of pain during external cephalic version at term. Acta Obstet Gynecol Scand, 2005, 84(4), p. 748–751.

11. Grootscholten, K., Kok, M., Oei, G., et al. External cephalic version-related risks, a meta-analysis. Obstet Gynecol, 2008, 112(5), p. 1143–1151.

12. Hofmeyr, GJ., Kulier, R. External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews, 2012.

13. Kok, M., Cnossen, J., Gravendeek, L., et al. Clinical factors to predict the outcome of external cephalic version: A meta analysis. Am J Obstet Gynecol, 2008, 199(6), p. 630–637.

14. Kok, M., Cnossen, J., Gravendeek, L., et al. Ultrasound factors to predict the outcome of external cephalic version: a meta-analysis. Ultrasound Obstet Gynecol, 2009, 33, p. 76–84.

15. Kotaska, A., Menticoglou, S., Gagnon, R. Vaginal delivery of breech presentation. SOGC Clinical Practice Guideline No. 226, June 2009. J Obstet Gynaecol Can, 2009, 31(6), p. 557–566.

16. Nagy, J., Nyklova, E. Is fear of external cephalic version well-founded? Čes Gynek, 2008, 73(4), s. 254–260.

17. RCOG Guideline No. 20a, External cephalic version and reducing the incidence of breech presentation, 2010.

18. Reinhard, J., Sänger, N., Hanker, L., et al. Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): a prospective trial of vaginal breech versus cephalic delivery. Arch Gynecol Obstet, 2013, 287(4), p. 663–668.

19. Rijnders, M., Offerhaus, P., van Dommelen, P., et al. Prevalence, outcome and women´s experience of external cephalic version in low-risk population. Birth: Issue in Perinatal Care, 2010, 37(2), p. 124–133.

20. Velzel, J., de Hundt, M., Mulder, FM. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol, 2015, 195, p. 160–167.