Factors influencing success of external cephalic version and their clinical significance / 中华围产医学杂志

Objective:To analyze the factors influencing the success rate of external cephalic version (ECV) and to create a preoperative scoring scale for stratified management of pregnant women who were preparing for ECV.Methods:This prospective study was conducted on singleton pregnant women who underwent ECV without anesthesia in Fujian Maternity and Child Health Hospital from January 1, 2017, to December 31, 2019. Univariate (two independent samples t-test, Mann-Whitney U test, and Chi-square test) and multivariate logistic regression were used to screen the clinical characteristics affecting the success of ECV, and receiver operating characteristic (ROC) curve was used to determine the cut-off value and convert quantitative variables into dichotomous variables. The independent variables were scored according to the regression coefficient in multivariate logistic regression analysis, and then a preoperative scoring scale was created. The ROC curve was used to calculate the cut-off value for the scoring scale. The subjects were divided into low and high score groups according to the cut-off value. The area under the ROC curve was used for evaluating the effectiveness of the scale in predicting the success of ECV. The success rate of ECV, difficulty of the operation and mode of delivery were compared between the two groups. Results:A total of 1 338 pregnant women met the inclusion criteria during the study period. After the exclusion of 885 women, 165 refused ECV in favor of direct cesarean section, 27 spontaneously converted to cephalic position before ECV, 261 who voluntarily accepted ECV were finally enrolled. ECV succeeded in 202 cases and failed in 59. (1) Favorable factors for ECV without anesthesia were the distance between the fetal breech and ischial spine <－3.5 cm ( OR=0.177, 95% CI: 0.071-0.438, P=0.009), the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm ( OR=0.225, 95% CI: 0.094-0.537, P=0.001), amniotic fluid index ≥12 cm ( OR=0.399, 95% CI: 0.164-0.969, P=0.042), the surgeon's ability to hold the fetal head or breech with one hand ( OR=0.241, 95% CI: 0.098-0.589, P=0.002; OR=0.219, 95% CI: 0.087-0.546, P=0.001), and the fetal head located on the right or left upper abdomen of the mother ( OR=0.184, 95% CI: 0.059-0.568, P=0.003; OR=0.253, 95% CI: 0.084-0.760, P=0.014). (2) The area under the ROC curve of the preoperative score for predicting the success of ECV was 0.881 (95% CI: 0.821-0.941) and the cut-off value was 5.5. The subjects were divided into low (0-5 scores) and high (6-11 scores) score groups and the area under the ROC curve for predicting the success of ECV by grouping was 0.843 (95% CI: 0.774-0.912). Compared with the low score group, the high score group had a shorter ECV duration [2.0 min (0.5-10.0 min) vs 10.0 min (0.9-25.8 min), Z=－6.83, P<0.001], less attempts [1.0 times (1.0-4.0 times) vs 3.0 times (1.0-5.0 times), Z=－8.41, P<0.001], higher success rate [92.7% (190/205) vs 21.4% (12/56), χ2=127.64, P<0.001], higher rate of vaginal birth [75.4% (147/195) vs 18.5% (10/54)] and lower cesarean section rate [24.6% (48/195) vs 81.5% (44/54)] ( χ2=58.70, P<0.001). Conclusions:Preoperative scoring based on the factors influencing the success rate of ECV (the distance between the fetal breech and ischial spine, the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm, amniotic fluid index ≥12 cm, the surgeon's ability to hold the fetal head or breech with one hand, and the fetal head locating on the right or left upper abdomen of the mother) is conducive to the individualized evaluation of the difficulty and the success rate of ECV as well as the success rate of vaginal delivery after ECV, which can provide a reference for clinical stratified management of ECV patients.

Embarazo triple espontáneo en una paciente con útero didelfo: reporte de un caso y revisión de la bibliografía / Spontaneous triplet pregnancy in a patient with uterus didelphys: report of a case and review of the literature

Resumen ANTECEDENTES: Las anomalías müllerianas implican la desviación de la anatomía normal del aparato reproductor femenino debido a un desarrollo embriológico alterado. Padecer alguna de estas anomalías, en cualquier escenario de su amplio espectro, suele asociarse con infertilidad o desenlaces obstétricos adversos, como la pérdida gestacional temprana o el parto pretérmino. CASO CLÍNICO: Paciente de 21 años, sin antecedentes patológicos relevantes, con dos embarazos finalizados: el primero por cesárea y el segundo por parto (la cesárea se indicó por la presentación podálica, a las 32 semanas). Acudió a un centro de referencia de la ciudad de Medellín, Colombia (Clínica Universitaria Bolivariana) a la primera consulta prenatal a las 17 semanas y 4 días de embarazo, motivada por un cuadro clínico de cólico biliar, sin requerimiento de intervenciones. Se trataba de embarazo triple, monocorial, triamniótico, con diagnóstico de útero didelfo a las 17 semanas y 1 día, con ambos cuellos uterinos reportados en 38 mm. La gestación finalizó a las 28 semanas y 4 días con el nacimiento de tres niños, quienes luego de superar los retos de la prematurez, en la actualidad llevan una vida normal. CONCLUSIONES: Las anomalías müllerianas, en su amplio espectro de manifestación clínica, son una condición que se asocia con una mayor frecuencia de desenlaces adversos materno-perinatales que se incrementan cuando la anomalía se relaciona con un embarazo múltiple. En la bibliografía actual no abundan los reportes de casos que combinen ambas condiciones, ni con recomendaciones oficiales estandarizadas para la atención médica de las pacientes, sobre todo para el escenario de embarazo triple y útero didelfo.

Abstract BACKGROUND: Müllerian anomalies involve deviation from the normal anatomy of the female reproductive tract due to altered embryological development. Having any of these anomalies, in any of their broad spectrum, is often associated with infertility or adverse obstetric outcomes, such as early gestational loss or preterm delivery. CLINICAL CASE: 21-year-old female patient, with no relevant pathological history, with two pregnancies terminated: the first by cesarean section and the second by delivery (the cesarean section was indicated due to breech presentation, at 32 weeks). She attended a referral center in the city of Medellín, Colombia (Clínica Universitaria Bolivariana) for the first prenatal consultation at 17 weeks and 4 days of pregnancy, motivated by a clinical picture of biliary colic, without requiring interventions. The pregnancy was triple, monochorionic, triamniotic, with a diagnosis of didelphic uterus at 17 weeks and 1 day, with both cervix reported at 38 mm. The gestation was terminated at 28 weeks and 4 days with the birth of three infants, who after overcoming the challenges of prematurity, are now living normal lives. CONCLUSIONS: Mullerian anomalies, in their broad spectrum of clinical presentation, are a condition that is associated with an increased frequency of adverse maternal-perinatal outcomes that are increased when the anomaly is associated with multiple pregnancy. The current literature does not abound with case reports combining both conditions, nor with standardized official recommendations for patient care, especially in the setting of triple pregnancy and didelphic uterus.

Learning curve for ultrasound-guided external cephalic version without anesthesia in full-term and near-term pregnancies / 中华围产医学杂志

Objective:To evaluate the effects of physician skills on the success rate of the external cephalic version (ECV) and investigate the learning curve for ECV.Methods:A retrospective study of 97 pregnant women who underwent ECV at the First Affiliated Hospital of Nanjing Medical University from March 2019 to August 2021 was performed. Patients were divided into multipara and primipara groups. The success rate of ECV and morbidity were compared between the two groups, and the learning curve for ECV was evaluated using cumulative sum analysis (CUSUM).Results:(1) Patients in the multipara group were older than those in the primipara group [(33.0±3.4) vs (29.2±3.0) years, t=－5.57, P<0.001]. No significant difference was found in other baseline data between the two groups. (2) The overall ECV success rate was 61.9% (60/97), and a higher success rate was observed in the multipara group [93.3% (28/30) vs 47.8% (32/67), χ 2=18.24, P<0.001]. Fetal heart rate deceleration (5.2%, 5/97), vaginal bleeding (1.0%, 1/97), premature rupture of membranes (1.0%, 1/97), and fetal distress (1.0%, 1/97) were the main complications. (3) The CUSUM analysis showed that it needed 53 primiparas for a physician to obtain a 50% consistent success rate ( R2=0.91, H=－3.27, Y=52.16) and seven multiparas to achieve a 70% consistent success rate ( R2=0.99, H=－1.635, Y=6.60). Conclusions:Parity and operator skills have a significant influence on the success of ECV. A physician with standardized training will manage non-anesthesia ECV skillfully in full-term and near-term pregnancies after practice on 50 primiparae or approximately ten multiparae. It is recommended to start with the multiparae for learning ECV to build up confidence and promote the implementation of ECV.

Neonatal outcomes in twin pregnancies with the first twin in breech presentation according to the mode of delivery: A cohort study from Dakar Senegal

The objectives of this study were to compare perinatal outcomes in twin pregnancies where the first twin was in the breech presentation. To do so, we performed a 10-year retrospective cohort study in a single university center. All patients with a twin pregnancy with the first twin in breech presentation, a gestational age greater than or equal to 34 weeks' gestation, and a birth weight >= 1500 g were included. The main outcome measures were 5-minute Apgar score <7 and perinatal mortality. We included 353 pairs of twins which complied with the inclusion criteria. One hundred and fifty (150) patients delivered vaginally while 203 pairs of twins were delivered by caesarean section. Patients who delivered abdominally were similar to those who delivered vaginally with regard to age, parity, and gestational age. Six twins A delivered vaginally and 2 delivered by caesarean section had an Apgar score < 7 (p = 0.76) whereas 12 twins B delivered vaginally and 2 delivered abdominally had an Apgar score <7 (p = 0.001). Perinatal mortality did not differ significantly between twins delivered abdominally and those delivered vaginally. There was no evidence that vaginal delivery was risky with regards to depressed Apgar scores for Twin A and neonatal mortality for breech first twins that weighed at least 1500 g. However, Twin B delivered vaginally were more likely to present with a low 5-minute Apgar score. Along with the literature, the findings of this study do not currently allow to define a consensual obstetric attitude towards management of breech first twin deliveries. Until more prospective multicenter randomized controlled studies shed light on this problem, the skills, experience and judgment of the obstetrician will play a major role in the decision-making process. (Afr J Reprod Health 2022; 26[5]: 50-56).

Correction rates and safety of acupuncture and moxibustion for treating breech presentation / 全日本鍼灸学会雑誌

[PURPOSE] To evaluate the efficacy and safety of acupuncture and moxibustion treatments in breech presentation, we report correction rates and adverse events for correcting breech presentation in our department.[PARTICIPANTS AND METHODS] Subjects were pregnant women who were diagnosed with breech presentation in our obstetrics and gynecology department and started acupuncture and moxibustion treatment between April 1, 2009 and October 31, 2018. The target patients were retrospectively investigated by medical records. The main items investigated were the status of the pregnant women at the time of acupuncture and moxibustion initiation (presence or absence of threatened preterm labor), treatment position (sitting or lateral position), correction rates and occurrence of adverse events. Successful correction was defined as the rate of head position after acupuncture and moxibustion treatments. Adverse events were defined as "unfavorable medical events occurring during or after treatment, regardless of causation."[RESULTS] There were 371 pregnant women in the study; among them 57 women were diagnosed with threatened preterm labor at the start of acupuncture and moxibustion treatment, including 21 pregnant women who were in the hospital. The sitting position was used for treatment for 45.2% (168 cases) of subjects and lateral position was used for 54.7% (203 cases). The correction rates were 72.2% (268/371). In pregnant women with threatened preterm labor who were hospitalized at the time of acupuncture and moxibustion initiation, the correction rates were 28.6% (6/21 cases), which was significantly lower than that of outpatient pregnant women. There was no significant difference in the rate of correction by treatment position between sitting and lateral position. There were no adverse events of vagal reflexes when the left lateral position was treated. The frequency of adverse events per number of procedures was 1.1% (21/1916) and per number of cases was 5.7% (21/371 cases). There were two cases of rupture of membranes with no apparent causal relationship.[CONCLUSION] The safest position for treatment in pregnant women was considered to be the left lateral position. Most of the adverse events were minor or moderate, but there were two cases of rupture of membranes with no apparent causal relationship. When performing acupuncture and moxibustion for breech presentation, it is necessary to work closely with the patient's obstetrician.

Is vaginal breech delivery still a safe option? / Será o parto pélvico vaginal uma opção segura?

Abstract Objective: To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. Methods: A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. Results: Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. Conclusion: The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.

Resumo Objetivo: Avaliar se existem diferenças nos desfechos perinatal e materno entre os partos pélvicos vaginais e eutócicos. Métodos: Realizou-se um estudo retrospectivo, caso controle, entre janeiro de 2015 e dezembro de 2017 em um hospital terciário em Portugal. Foram incluídos 26 casos de parto pélvico vaginal e o grupo controle foi formado por 52 grávidas. Resultados: A indução do trabalho de parto ocorreu com mais frequência no grupo do parto pélvico vaginal (46% versus 21%, p = 0.022), bem como a realização de episiotomia (80% versus 52%, p = 0.014). Verificou-se um caso de laceração perineal de 3° grau. Os recém-nascidos do grupo de estudo apresentaram um peso inferior ao nascimento (2.805 g versus 3.177 g, p < 0.001). Em relação aos desfechos perinatais, não se observaram diferenças estatisticamente significativas. Conclusão: O presente estudo mostrou que o parto pélvico vaginal no termo quando comparado com o parto eutócico não se associou a diferenças estatisticamente significativas na morbidade perinatal e materna, e sugere ainda que o parto pélvico vaginal parece ser uma opção segura em casos rigorosamente selecionados e na presença de um obstetra experiente.

Evaluating the factors influencing perinatal outcome in breech presentation

Background: The objective of this study was to analyse the current obstetric practice regarding breech presentation, document the incidence, perinatal outcome and the factors influencing perinatal outcome in breech deliveries.Methods: It was a retrospective observational study including 252 cases of breech presentation during January 2018 to December 2019 in a tertiary teaching institute in Vidarbha region of Maharashtra.Results: Total number of breech deliveries 252 (incidence is 2.5%). Caesarean section for breech presentation 95 (37.6%). With vaginal deliveries the Apgar score at 5 min below 7 were among 48 out of 157 breech deliveries whereas with LSCS it was only amongst 7 out of 95 deliveries. The maximum percentage of perinatal mortality is seen with birth weight below 2000 gm. Maximum mortality is seen prior to 32 weeks and in babies who delivered by vaginal route. Respiratory distress with prematurity and severe birth asphyxia are the common causes of perinatal deaths. Total 32 (12.69%) babies were transferred to NICU. 20.38% of the total vaginal breech deliveries and 5.26% of the total LSCS were transferred to NICU. Out of total 32 NICU admissions 22 are for the preterm babies and babies with birth weight below 2000 gm.Conclusions: The perinatal outcome does not depend only on the mode of delivery, it is also affected by the weight of the baby, its maturity, associated congenital anomalies, equipped neonatal intensive care unit and also substantially on the expertise of the obstetrician and the neonatologist.

Pregnancy outcome of external cephalic version in singleton pregnancy with breech presentation at term

Background: Breech delivery is associated with poor perinatal outcomes irrespective of the route of delivery. External cephalic version can be a useful tool in management of breech presentation at term by converting it to a cephalic presentation. A study was conducted to evaluate maternal and neonatal outcome of external cephalic version in singleton pregnancies with breech presentation in third trimester.Methods: A prospective observational study was carried out at a tertiary care hospital over a period of 2 years. This study included a total of 65 uncomplicated cases of breech presentation who fulfilled the inclusion criteria. External cephalic version was carried out after 36 weeks of period of gestation in primigravida and after 37 weeks in multigravida women. These patients were followed up till delivery and data was collected and analysed regarding the mode of delivery, maternal and fetal outcome.Results: External cephalic version was successful in 41 patients with a success rate of 63%. Out of them, vaginal delivery could be achieved in 31 cases (75.6%) and LSCS was done for rest of the 10 cases. The success rate was higher in multigravida ladies compared to primigravida ladies. No major procedure related adverse event was noticed in our study.Conclusions: External cephalic version is a very safe and easy procedure which can reduce the rate of cesarean delivery in singleton pregnancies with breech presentation. The results of this study are in favor of wider practice of this procedure in selected cases.

An interesting case report of ruptured pyogenic liver abscess with 40 weeks gestation in labour

Pyogenic liver abscess during pregnancy is an extremely rare condition. Although rare, in situations of sepsis or septic shock in pregnancy, as well as the common sources of infection, a possibility of a liver abscess should be considered. We present a case report of 32-year-old primigravida 37.3 weeks by date, 37 weeks by scan with breech presentation with premature rupture of membranes and pain in abdomen since 12 hours with breathlessness, fever and diarrhoea since 2 days came in emergency to study hospital. General condition of the patient on arrival was pulse-140 beats per minute, blood pressure was 90/60 mmHg, respiratory rate was 40/min, on per abdominal examination, breech presentation with fetal heart rate of 150 beats per minute on doppler was noted. Per vaginal examination revealed cervical os 5 cm dilated, 40% effacement, breech presentation, absent membranes. With urgent report of complete hemogram and acid blood gas analysis, metabolic acidosis was noted which was corrected and patient was taken for emergency lower segment caesarean section. Intra-operative, 250 ml greenish pus flakes fluid was noted inside the abdominal cavity. Fluid was drained and sent for culture sensitivity with maximum aseptic precautions, uterus was opened, baby was delivered followed by uterus closure. Ruptured liver abscess 6×4×2 cm in 2nd and 3rd segment of liver was noted, abdominal wash with antibiotics and NS was given, drain was kept. Appropriate antibiotics were started and was discharged on day 14 after suture removal.

Etiological factors and maternal outcome in pregnancies with malpresentation: an observational study

Background: The most common presentation of the fetus is malpresentation. These include breech, face, brow, shoulder and compound presentations. Malpresentations of fetus complicate labor in about 5% of pregnancies. To find out the incidence of malpresentation, to analyze etiological factors of malpresentation, to evaluate the maternal outcome in cases with a malpresentation.Methods: This prospective observational study was done in, Chengalpattu Government medical college and hospital. Study period from October 2018 to September 2019. Pregnancies with malpresentation presenting to the department of obstetrics and gynecology at CMCH were included in the study.Results: A total of 680 malpresentation were admitted in this period were included in this study. The incidence of malpresentation during the study period was 7.72%. The incidence of the breech was 4.38%, transverse lie 1.11%, face 0.28%, brow 0.05% and compound presentation 0.13%. The common causes were prematurity, multiple gestations, grand multiparty, IUGR, oligohydramnios, anomalies of uterus, polyhydramnios, contracted pelvis, placenta previa, hydrocephalus, prematurity was reported as the commonest cause of breech presentation and multiparty for transverse lie, face and brow presentations. The most common complication was obstructed labor 6.9% followed by post-partum hemorrhage 3.65%. There was no maternal death due to malpresentation during the period of study.Conclusions: Early diagnosis and timely management can prevent the complications of labor associated with a malpresentation. Delivery should be planned at centers which have expertise in conducting vaginal delivery in malpresentation with good intrapartum monitoring and with facilities for cesarean section for the better feto-maternal outcome.

A prospective observational study of breech pregnancy in a tertiary care centre

Background: Breech presentation is the commonest of all mal presentations. Vaginal delivery of breech presentation at term is associated with a much higher perinatal mortality and morbidity than that of vertex presentation.Methods: This prospective study was carried out in the department of obstetrics and gynaecology, S. S. G. Hospital, Baroda for a period of six months from 1st May 2019 to 31st October 2019. Out of a total number of 4476 deliveries, 159 were breech pregnancy. It included all the women admitted in labour room or ward who delivered with clinical or ultrasound diagnosis of breech presentation after 20 weeks of gestation.Results: In the present study incidence of breech pregnancy was 3.6%. Authors observed the highest incidence of breech pregnancy in the age group of 20 to 25 years. Maximum (62.9%) cases delivered after 37 weeks of gestation. In our study 62.3% cases were primigravida and 37.7% were multigravida. Majority of cases (77.4%) delivered by caesarean section. Among all the babies born 50.6% were having birth weight of less than 2.5 kg.Conclusions: Authors need to study and analyse all cases of breech pregnancy individually to decide the management and mode of delivery depending on cases to case basis and expertise of the staff available. Delivery of breech foetus should be conducted by experience obstetrician after appropriate consent from pregnant women and her relatives.

Height of elevated fetal buttock for prediction of successful external cephalic version

14 cm, and HOB >7.8 cm were 10.80 (95% confidence interval [CI], 1.57–74.94), 5.26 (95% CI, 1.06–26.19), and 10.50 (95% CI, 1.03–107.12), respectively. Areas under the curve (AUCs) for AFI, HOB, and parity were 0.66 (95% CI, 0.54–0.78), 0.74 (95% CI, 0.64–0.85), and 0.69 (95% CI, 0.62–0.76), respectively. HOB had the largest AUC, but there were no significant differences among the AUCs of other factors. The cut-off value of HOB was 6 cm.CONCLUSION: This study showed that the AUC of HOB was greater than that of parity and AFI, although it was not statistically significant. As HOB is a noninvasive and comprehensive marker to predict successful ECV, consideration of HOB would be helpful before conducting ECV. Further studies are needed.

Breech presentation delivery care: A review of childbirth semiology, mechanism and care / Atención del parto con feto en presentación pelviana: revisión de la semiología, el mecanismo y la atención del parto

RESUMEN Objetivo: revisar los conceptos que subyacen al trabajo de parto con feto en presentación pelviana, su semiología y las maniobras obstétricas que facilitan un resultado materno perinatal exitoso. Materiales y métodos: a partir de un caso hipotético que ambienta de manera práctica el tema, se crea un documento explicativo construido a partir de una revisión narrativa, en donde se examinan los preceptos relacionados con el diagnóstico, el mecanismo del parto en presentación pelviana y el manejo intraparto de la gestante, con énfasis en la adecuada ejecución de las maniobras que facilitan la extracción fetal. Resultados: el parto en presentación pelviana debe ser atendido por vía vaginal cuando se encuentra en periodo expulsivo con encajamiento cumplido. Para su diagnóstico y atención es esencial hacer una adecuada identificación de la presentación, así como conocer su fisiología, la indicación y adecuada ejecución de las maniobras obstétricas que facilitan un parto sin complicaciones. Conclusiones: el mecanismo del parto en presentación pelviana es complejo y requiere, cuando no hay otra alternativa para la atención, que tanto el obstetra como el médico general conozcan su fisiología y las múltiples maniobras obstétricas que facilitan obtener buen resultado materno perinatal.

ABSTRACT Objective: To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods: Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results: Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Conclusions: The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.

Breech presentation at term: outcomes and mode of delivery in a tertiary care teaching hospital In South India

The aim of this study was to study the outcomes of all patients who presented with breech presentation at term (≥37 weeks), to assess what percentage of patients were offered External cephalic version (ECV), the rates of success of the procedure and the rates of vaginal delivery following successful ECV. It was a retrospective study of 669 patients diagnosed with breech at term, their clinical records were retrieved and data like age, BMI, parity, type of breech and scan findings noted. ECV was done in 256 patients and was successful in 35.5% of women with 51.1% being multigravidas and 26.8% in primigravidas. 76.9% of women with successful ECV delivered vaginally.  There was no significant fetal or maternal morbidity documented as a result of ECV in this study.

Cesarean section of breech presentation-the prevention of newborn fracture / 中国实用妇科与产科杂志

The breech presentation is a common occurrence in the obstetrical practice,accounting for about 3-5% of singleton fetuses at delivery.The Term Breech Trial demonstrated the planned cesarean section to be associated with a significant reduction in perinatal mortality and short term morbidity.Although the safety of cesarean section is widely reported,there is still a certain proportion of neonatal injuries,especially fracture.This paper focuses on the neonatal birth injury by cesarean section of breech presentation and the corresponding preventive measures and treatment,in order to reduce the newborn injury as much as possible.

Success rate and influencing factors of external cephalic version for singleton pregnancies in the third trimester / 中华妇产科杂志

Objective To investigate the factors associated with the success rate of external cephalic version (ECV) for singleton and non-cephalic presentation pregnancies in the third trimester.Methods A retrospective study of ECV among singleton and non-cephalic presentation pregnant women in 36-40 weeks of gestation at Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2016 to June 2018 was analyzed.Results (1) Totally,251 cases of 358 pregnant women who underwent ECV were successful,with a total success rate of 70.1％ (251/358).The success rate of multipara was 79.1％ (129/163),while 62.6％ (122/195) in primipara (P＜0.01).The total vaginal delivery rate was 52.2％ (187/358),the vaginal delivery rate of multipara was 61.3％ (100/163),while 44.6％ (87/195) in primipara (P＜0.01).(2) Spontaneous reversion occurred in 7.6％(19/251) of ECV successful women,the rate of reversion of multipara was 10.9％ (14/129),higher than that of the primipara [4.1％ (5/122);P＜0.01].(3) Among the 232 pregnant women who did not reverted after successful ECV,187 cases of successful vaginal delivery,the vaginal delivery rate was 80.6％ (187/232);the vaginal delivery rate of the multipara was 87.0％(100/115),which was higher than that of the primipara [74.4％(87/117);P＜0.01].(4) The variables significantly associated with ECV success were parity,type of breech,whether fetal presentation was in pelvic or not (all P＜0.05).The complication rate was 2.2％ (8/358),among which the incidence of fetal distress,placental abruption and transient fetal heart abnormalities were 0.6％ (2/358),0.3％ (1/358) and 1.4％ (5/358) respectively.Conclusion By close monitoring,ECV is a safe and effective procedure in selected appropriate cases,and worthy of clinical application.

Reviving external cephalic version: a review of its efficacy, safety, and technical aspects

Currently, the rate of cesarean sections being performed in Korea is approximately 40%, with Korea ranking 4th among the Organization for Economic Co-operation and Development countries with respect to cesarean deliveries. Breech presentation at term is an important indication for cesarean section among other factors, including medicolegal concerns and pregnancies in women of advanced maternal age. Term breech presentation is associated with a higher fetal mortality rate than that associated with a cephalic presentation. Therefore, in Korea, most of these women deliver by cesarean section to avoid the complications of vaginal breech delivery. However, cesarean section is itself associated with considerable obstetric morbidity and sometimes, mortality. External cephalic version (ECV) is a useful method to reduce the cesarean section rate in women with breech presentation and therefore to reduce the incidence of breech presentation at delivery. Studies have shown that routine use of ECV reduces the cesarean section rate by approximately two-thirds in term pregnancies with breech presentation. ECV is accepted as a safe, efficacious, and cost-effective method and is recommended by both the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists in all pregnancies with term breech presentation, if not contraindicated. In Korea, although most clinicians are aware of the option of ECV, their relative lack of experience in performing the procedure and fear of complications render them hesitant to perform ECV. This review is aimed at guiding obstetricians by describing the efficacy, safety concerns, and technical aspects of this procedure.

Applying the newman-peacock prognostic system to a portuguese obstetrical population - A useful tool? / Utilização do modelo de prognóstico Newman-Peacock numa população obstétrica portuguesa - uma ferramenta útil?

Abstract Background External cephalic version (ECV) is a maneuver that enables the rotation of the non-cephalic fetus to a cephalic presentation. The Newman-Peacock (NP) index, which was proposed by Newman et al. in a study published in 1993, was described as a prediction tool of the success of this procedure; it was validated in a North-American population, and three prognostic groups were identified. Purpose To evaluate the value of the NP score for the prediction of a successful ECV in a Portuguese obstetrical population, and to evaluate maternal and fetal safety. Methods We present an observational study conducted from 1997-2016 with pregnant women at 36-38 weeks of pregnancy who were candidates for external cephalic version in our department. Demographic and obstetrical data were collected, including the parameters included in the NP index (parity, cervical dilatation, estimated fetal weight, placental location and fetal station). The calculation of the NP score was performed, and the percentages of success were compared among the three prognostic groups and with the original study by Newman et al. The performance of the score was determined using the Student t-test, the Chi-squared test, and a receiver operating characteristic (ROC) curve. Results In total, 337 women were included. The overall success rate was of 43.6%. The univariate analysis revealed that multiparity, posterior placentation and a less engaged fetus were factors that favored a successful maneuver (p < 0.05). Moreover, a higher amniotic fluid index was also a relevant predictive factor (p < 0.05). The Newman-Peacock score had a poorer performance in our population compared with that of the sample of the original study, but we still found a positive relationship between higher scores and higher prediction of success (p < 0.001). No fetal or maternal morbidities were registered. Conclusions The Newman-Peacock score had a poorer performance among our population compared to its performance in the original study, but the results suggest that this score is still a useful tool to guide our clinical practice and counsel the candidate regarding ECV.

Resumo Âmbito A versão cefálica externa (VCE) é uma manobra que permite a obtenção de uma apresentação cefálica em fetos não-cefálicos. O índice de Newman-Peacock (NP), proposto por Newman et al em um estudo publicado em 1993, foi descrito como preditivo do sucesso desta manobra; ele foi validado numa população norte-americana, e três grupos de prognóstico diferentes foram identificados. Objectivo Avaliação do valor preditivo do índice de NP para o sucesso da VCE numa população obstétrica portuguesa, bem como da segurança materno-fetal. Métodos Foi realizado no nosso departamento umestudo observacional entre 1997- 2016 em grávidas candidatas a VCE entre as 36 e as 38 semanas de gravidez. Foram colhidos dados demográficos e obstétricos, incluindo os parâmetros incluídos no índice de NP (a paridade, a dilatação cervical, a estimativa do peso fetal, a localização placentária e a altura da apresentação fetal). A pontuação das candidatas de acordo como índice de NP e a percentagemde sucesso da VCE foramcomparadas entre os três grupos de prognóstico, e também com o estudo original de Newman et al. O desempenho deste índice foi avaliado recorrendo aos testes t de Student, qui-quadrado e curva receiver operating characteristic (ROC). Resultados Foram incluídas 337 mulheres. A taxa de sucesso da manobra foi de 43,6%. A análise univariada mostrou que a multiparidade, a placentação posterior e uma apresentação não encravada foram favoráveis para o sucesso do procedimento (p < 0,05). Adicionalmente, um maior índice de líquido amniótico revelou-se também como um fator preditivo significativo (p < 0,05). O índice de Newman-Peacock apresentou um desempenho inferior na nossa população comparativamente à sua descrição original, porém continuou a verificar-se uma relação positiva entre pontuações mais elevadas e uma maior percentagem de sucesso (p < 0,001). Conclusão No nosso trabalho, o índice de Newman-Peacock apresentou um valor preditivo inferior comparativamente ao estudo original, porém os resultados mostram que se mantém uma ferramenta com utilidade para a prática clínica e para o aconselhamento das candidatas a versão cefálica externa.

Clinical Characteristics and Outcomes of 80 Pregnant Women after External Cephalic Version / 中山大学学报(医学科学版)

[Objective] To investigate the safety and associated factor of external cephalic version (ECV) in third trimester,and to enrich clinical experience to improve the successful rate and lower cesarean section (CS) rate.[Methods] 80 pregnant women conducting ECV in third trimester in the third affiliated hospital of Sun Yat-sen University from September 2015 to July 2017 were enrolled in our study.Divided to successful group and failing group,we compared the clinical characters and pregnancy outcomes.[Results] Of the 80 pregnancy,48 women (60.0％) succeed with cephalic presentation.Compared to the failing group,the successful group is statistically different in parity,BMI and amniotic fluid depth.In the failing group,all women underwent CS with 3/48 in successful group.No women conducted ECV complicated fetal distress and emergency CS,premature rupture of membranes complicated in 11 (13.8％) cases in all women.[Conclusions] ECV is safe for mother and fetus.Encouraging the suitable pregnancy women to conduct ECV and enhancing clinical skills can improve ECV success rate.

External cephalic version without anaesthesia for breech presentation in singleton term pregnancies:a retrospective analysis of 195 cases / 中华围产医学杂志

Objective To investigate the safety and effectiveness of external cephalic version for breech presentation in singleton term pregnancies. Methods This study retrospectively analyzed the clinical data of 195 singleton pregnancies with gestational weeks ≥37 and breech presentation that has received external cephalic version in University of Hong Kong-Shenzhen Hospital from January 2014 to December 2016. The success rate of external cephalic version, delivery modes, maternal and neonatal complications and adverse outcomes were analyzed. Results Of the 195 cases, 62.6% (122/195) were successful, among which 107 vaginally delivered and 15 underwent the cesarean section. Maternal and neonatal outcomes of all 195 cases were good. The success rate of external cephalic version in the multipara was higher than that of the primipara [84.5%(71/84) vs 45.9%(51/111), χ2=30.383, P<0.001]. No neonatal asphyxiation or postpartum hemorrhage was reported. Conclusions External cephalic version is an effective and safe method to convert breech presentation and reduce cesarean section rate in the third trimester.