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.

Early versus late external cephalic version

To find out whether initiating external cephalic version [ECV] earlier in pregnancy increase the rate of successful ECV procedures, and be more effective in decreasing the non cephalic presentations at birth and also cesarean section rate. This interventional study was conducted in Department of Obstetrics and Gynecology Mardan Medical Complex from first July 2010 to 31[st] Dec 2011.It included women with singleton breech fetus at a gestational age of 34 to 35 weeks. Patients were randomly divided into two groups, those having a first ECV procedure between 34[238 days] and 35 weeks of gestation were called early ECV group the second group included those who had first ECV at or after 37 weeks[259 days] and were called delayed ECV group. Percentages were calculated for qualitative variables like Gravida, complications etc, while mean and SD for quantitative variables like gestational age. Out of total 203 women who had breech presentation 123 were finally selected for the trial. Early ECV group included 63 patients while delayed group included 60 patients.. Fewer fetuses were in non cephalic presentation at birth in the early ECV group [41/63[65%] versus 29/60[49%] in the delayed ECV group, p = 0.04. There were no differences in rates of cesarean section [19/63[30%] versus 20/60 [33%],p=0.42] in the early ECV group versus the delayed ECV group. The rate of preterm birth was not different between groups, early ECV group [2/63[3%] versus 0/60[o], p=o.26] delayed ECV group. External cephalic version at 34 and 35 weeks increase the likelihood of cephalic presentation at birth but it does not decrease the rate of cesarean sections and may increase the rate of preterm birth in the early ECV group

Accouchement en présentation de siège à la maternité Issaka Gazoby de Niamey aspects épidémiologiques, cliniques, paracliniques thérapeutiques et pronostiques. A propos d'une étude rétrospective de 812 cas sur une période de 5 ans (01 janvier 2008 au 31 décembre 2012)

L'accouchement en présentation de siège demeure une préoccupation à cause de la morbidité et de la mortalité qu'il entraine. Les progrès de l'obstétrique en général et de l'imagerie en particulier ont contribué à la réduction de la mortalité dans les pays développés. Elles demeurent toujours élevées dans les pays en développement comme le Niger OBJECTIFS GENERAL Evaluer la prise en charge de l'accouchement en présentation de siège en vue de contribuer à la réduction de la morbidité et de la mortalité maternelle et périnatale. OBJECTIFS SPECIFIQUES 1. Evaluer la fréquence de l'accouchement en présentation de siège ; 2. Décrire le profil épidémiologique des patientes ; 3. Evaluer la prise la prise en charge de l'accouchement en présentation de siège ; 4. Evaluer le pronostic maternel et périnatale ; 5. Faire des recommandations adaptées pour réduire la morbidité et la mortalité maternelles et périnatales. Pour atteindre ces objectifs nous avons réalisé une étude rétrospective type analytique couvrant la période du 1er janvier 2008 au 31 décembre 2012 à la MIG. Seules les patients présentant des grossesses multiples ou un termes inferieur à 22 SA ont été exclues. Au total nous avons retenus 812 patients sur une population de 25516. RESULTATS La fréquence est de 3,18%. L'âge moyen était de 27,3% avec des extrêmes allant de 15 à 48 ans. 64,3% des patients n'étaient pas 127 scolarisées. Et 80,3% étaient sans-emploi. Les nullipares étaient les plus concernées par ce type de présentation (32,0%). 76,7% étaient des transferts in utero avec 62,2 % de la CUN et 35,6% des autres régions. Les principaux motifs de transfert in utero étaient : primiparité et siège (15,4%), utérus cicatriciel et siège (7,62%), RPM et siège (6,2%). Pour le suivi de la grossesse (30,7%) des patients n'avaient fait aucun CPN et 43,3% avaient fait au moins 3 CPN. 5,2% avaient fait l'échographie du 3e trimestre de la grossesse. Prise en charge de l'accouchement La voie basse a représenté 36,0% des patientes contre 64,0% de césarienne. Le pronostic périnatal est domine par la mortalité périnatale (27,9%), les malformations (5,0%), la morbidité traumatique représente 0,9%. Le pronostic maternel est dominé par la morbidité qui représente 15,9% dont l'anémie vient en première place avec 6,7% ; les infections bactériennes (4,2%) ; HTA (2,5%) ; les suppurations pariétales (2,3%). Aucun décès maternel n'a été enregistré. Conclusion L'absence d'instruction, le manque de suivi prénatal, la qualité des transferts in utero, l'âge maternel sont autant de facteur de risque en cas de présentation de siège. Une amélioration des soins obstétricaux et néonataux d'urgence, des sensibilisations des patientes et des efforts budgétaires de l'état peuvent améliorer le pronostic maternel et périnatal

Maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term

To find out the maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term. This study was conducted at Lady Reading Hospital, Peshawar from 1st July 2000 to 30th June 2001 on patients presenting with singleton term breech. Multiple pregnancy and preterm breech were excluded. Information regarding,age, address, parity, gestational age, physical and vaginal examination, ultrasound findings, mode of delivery, any specific procedures performed including external cephalic version [ECV] was collected. Demographic variables and obstetrical outcome were observed in diagnosed and undiagnosed breech cases.Diagnosed breech cases were diagnosed antenatally and proper management plan decided, while undiagnosed breech cases were unbooked who came to hospital for 1st time in labour. Out of 203 cases, 163 [80.29%] patients presented with undiagnosed breech and 40[19.71%] had been diagnosed in antenatal clinic. Out of 163 undiagnosed cases, 137 [84.1%] had successful vaginal breech delivery [VBD], 22 [13.5%] cases had caesarean section [CS], three [1.8%] had subtotal hysterectomy for rupture uterus and 1 [0.6%] with successful ECV had normal vaginal delivery [NVD]. Among 40 diagnosed cases, 8[20%] had successful VBD, 22 [55%] had CS and 10 [25%] had successful ECV followed by NVD. There was no statistical significant difference in short term neonatal outcome, neonatal morbidity and mortality among both groups. Maternal morbidity was lower in vaginally delivered undiagnosed breech cases than in those delivered by caesarean section.In diagnosed group maternal morbidity was the same regardless of mode of delivery. Good prenatal care is essential to reduce undiagnosed breech cases at term. ECVreduces the incidence of Breech Presentation at delivery. In selected cases VBD is a safe option