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.

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.

Uso da moxabustão e acupuntura em gestantes com Apresentação pélvica: revisão integrativa / Use of moxibustion and acupuncture in pregnant women with breech presentation: an integrative review / Uso de la moxibustión y acupuntura en embarazadas con presentación de nalgas: revisión integrador

O objetivo deste estudo foi conduzir uma revisão integrativa a fim de identificar publicações sobre a moxabustão e acupuntura para versão de fetos em apresentação pélvica. A ferramenta de pesquisa Paciente, Intervenção, Comparação e Desfecho, disponibilizada pela base de dados da Biblioteca Nacional de Medicina dos Estados Unidos, foi utilizada para gerar uma lista de artigos. As palavras utilizadas para a busca foram os termos breech, moxibustion, acupuncture e cephalic. A busca foi realizada no mês de março de 2016. Foram encontrados 24 registros, 18 foram analisados, dentre os quais sete foram favoráveis ao uso da moxabustão, e cinco, desfavoráveis. A partir dos estudos realizados sobre o tema, há evidências de que a moxabustão seja segura e efetiva para tentar "corrigir" apresentações pélvicas, apresentando-se como uma ferramenta no complemento da assistência prestada por profissionais na área da obstetrícia (AU).

The objective in this study was to develop an integrative review to identify publications on moxibustion and acupuncture to turn fetuses in breech position. The research tool Patient, Intervention, Comparison and Outcome, available through the database of the United States National Library of Medicine, was used to produce a list of articles. The words used for the search were: breech, moxibustion, acupuncture and cephalic. The search was undertaken in March 2016. Twenty-four registers were found, 18 of which were analyzed, seven of them favorable to the use of moxibustion and five unfavorable. Based on the studies developed on the theme, there is evidence that moxibustion is safe and effective to try and "correct" breech presentations, as a tool to complement the care midwifery professionals provide (AU).

El objetivo de este estudio fue desarrollar una revisión integradora para identificar publicaciones sobre la moxibustión y acupuntura para versión de fetos en presentación de nalgas. La herramienta de investigación Paciente, Intervención, Comparación y Desfecho, publicada por la base de datos de la Biblioteca Nacional de Medicina de Estados Unidos, fue utilizada para generar un rol de artículos. Las palabras utilizadas para la búsqueda fueron: breech, moxibustion, acupuncture y cephalic. La búsqueda fue llevada a cabo en marzo del 2016. Fueron encontrados 24 registros, 18 fueron analizados, entre los cuales siete fueron favorables al uso de la moxibustión y cinco desfavorables. A partir de los estudios desarrollados sobre el tema, hay evidencias de que la moxibustión sea segura y efectiva para intentar "corregir" presentaciones de nalgas, siendo una herramienta para complementar la atención prestada por profesionales en el área de partería (AU).

Evaluation of the learning curve for external cephalic version using cumulative sum analysis

OBJECTIVE: We evaluated the learning curve for external cephalic version (ECV) using learning curve-cumulative sum (LC-CUSUM) analysis. METHODS: This was a retrospective study involving 290 consecutive cases between October 2013 and March 2017. We evaluated the learning curve for ECV on nulli and over para 1 group using LC-CUSUM analysis on the assumption that 50% and 70% of ECV procedures succeeded by description a trend-line of quadratic function with reliable R² values. RESULTS: The overall success rate for ECV was 64.8% (188/290), while the success rate for nullipara and over para 1 groups was 56.2% (100/178) and 78.6% (88/112), respectively. ‘H’ value, that the actual failure rate does not differ from the acceptable failure rate, was −3.27 and −1.635 when considering ECV success rates of 50% and 70%, respectively. Consequently, in order to obtain a consistent 50% success rate, we would require 57 nullipara cases, and in order to obtain a consistent 70% success rate, we would require 130 nullipara cases. In contrast, 8 to 10 over para 1 cases would be required for an expected success rate of 50% and 70% on over para 1 group. CONCLUSION: Even a relatively inexperienced physician can experience success with multipara and after accumulating experience, they will manage nullipara cases. Further research is required for LC-CUSUM involving several practitioners instead of a single practitioner. This will lead to the gradual implementation of standard learning curve guidelines for ECV.

External cephalic version experiences in Korea

OBJECTIVE: The aim of this study was to evaluate obstetric outcomes of external cephalic version (ECV) performed at or near term. METHODS: Single pregnant woman with breech presentation at or near term (n=145), who experienced ECV by one obstetrician from November 2009 to July 2014 in our institution were included in the study. Maternal baseline characteristic and fetal ultrasonographic variables were checked before the procedure. After ECV, the delivery outcomes of the women were gathered. Variables affecting the success or failure of ECV were evaluated. RESULTS: Success rate of ECV was 71.0% (n=103). Four variables (parity, amniotic fluid index, fetal spine position and rotational direction) were observed to be in correlation with success or failure of ECV. In contactable 83 individuals experienced successful ECV, cesarean delivery rates were 18.1%, 28.9%, and 5.3% in total, nulliparas, and multiparas, respectively. CONCLUSION: Based on the results, ECV is proposed to be safe for both mother and her fetus. In addition, it is a valuable procedure that increases probability of vaginal delivery for women with breech presentation.

Evaluation of the Success Rate Following Amnioinfusion in Pregnant Women Undergoing External Cephalic Version after Initial Failure

PURPOSE: To evaluate the success rate following amnioinfusion in pregnant women undergoing external cephalic version (ECV) after initial failure. METHODS: This prospective study enrolled 17 consecutive pregnant women from October 2013 to May 2015. ECV was performed with amnioinfusion after initial failure. The success rates of ECV and vaginal delivery, including pregnancy outcomes, were analyzed. RESULTS: ECV was performed at an average of 37.3±0.6 weeks of gestational age. Eight of seventeen patients were nulliparous. The estimated fetal weight was 2,688±279 g, and the amniotic fluid index was 6.4±2.6 cm. The overall success rate of ECV was 70.6% (12/17), and the success rates in nulliparous and multiparous women were 75.0% (6/8) and 66.7% (6/9), respectively. The rate of emergent cesarean section within 24 hours was 11.8% (2/17). Excluding one women who were lost to follow-up, the rate of normal vaginal delivery was 81.8% (9/11) among the women who had successful ECV. We did not observe any complications such as uterine rupture, placental abruption, or intrauterine fetal death. CONCLUSION: Although ECV with amnioinfusion after initial failure might help increase the success rate of ECV, it needs to be further evaluated in larger studies.

External cephalic version for breech presentation at term. A prospective interventional study

To evaluate the external cephalic version [ECV] procedure for the management of at term breech presenting fetuses. In this prospective, interventional study, 90 patients with uncomplicated breech presentations at or after 37 weeks' gestation were considered for ECV. This was performed in Al-Batool Teaching Hospital, Mosul, Iraq, between January 2011 and March 2012. The main outcome measure was assessed as the success rate of ECV attempt and the rate of cesarean section following a successful procedure. Parity, type of breech, placental location, and birth weight were evaluated as predictors of success. Also, any fetal or maternal complications during the procedure were evaluated. Data were analyzed by Chi-Square test. Statistical significance was determined at a level of p<0.05. The success rate was 80%. The rate of cesarean section following successful procedure was only 12.5%. Prognostic parameters associated with successful ECV were multiparity and flexed type of breech. There were no serious fetal or maternal complications associated with the attempt. With appropriate selection of patients, ECV is highly successful and is a safer alternative to vaginal breech delivery or cesarean delivery

Induction of labour; routive induction at 40 weeks of pregnancy

The aim of this study to justify induction of labour at 40 weeks of pregnancy in our population. Quasi experimental study. Combined Military hospital Attock, Obstetric and Gynaecology Department from 1.6.2011 to 1.2.2012. 100 patients were selected from outpatient department, and divided into two groups, group A, with 50 patients at 40 weeks and group B with 50 patients at 41 weeks. Booked or unbooked patients with singleton pregnancy with cephalic presentation, were selected by non propability consecutive sampling technique. Pregnancy with previous scar, medical disorder, polyhydramnios, multiple fetal and uterine abnormality and intrauterine death, placenta previa, were ruled out excluded from study. Postdate pregnancy was confirmed clinically by last menstrual period and early dating ultrasound. Patients were clinically followed for fundal height, presentations and FHR. Bishop scoring was done and patients were induced mechanically with cervical foley and vaginal pessary PGE2 according to bishop score. Amniotomy was done at bishop score more than 7. Labour was monitored with full protocol. Same procedure was repeated for group B of 50 patients who were selected according to criteria, for induction of labour at 40 weeks of pregnancy. Maternal and fetal outcome was analysed in term of mode of delivery and APGAR score respectively. Out of 100 patients, 50 patients with age 20 to 35 year, presenting at 40 weeks were included in group A. Spontaneous vaginal delivery was seen in 30 patients [60%], 4 by vaccum[8%], 3 by forcep delivery [6%], 13 patients ended up into emergency LSCS [26%]. In group B of 50 women, planned for induction at 41 weeks, emergency cesareans were 23 [46%]. MAS was in 9[18%] babies as compared to 2% in group A and, Fetal distress [type 2 dips] were found in 3[6%] cases. Neonatal outcome was assessed with help of APGAR score. Babies delivered with good APGAR were 47 in group A, as compared to 41 in group B. Rate of vaginal delivery was high in group A [74%] induced at 40 weeks. Results were analysed by using SPSS 10 and p-value was found to 0.024. No difference was found in the incidence of fetal outcome with APGAR SCORE 10, and fewer babies were with poor APGAR SCORE and p=0.051. Induction at 40 weeks may reduce perinatal mortality and incidence of MAS. It does not increase risk of caesarean section when compared with induction at or beyond 41 weeks

External cephalic version with salbutamol-Success rate and predictors of success

To determine the success rate of External Cephalic Version [ECV] with 0.25 mg Salbutamol in singleton term breech and to identify the predictors of success. Quasi experimental study. Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad, from January 2000 to March 2005. Women, presenting with uncomplicated breech, between 37-40 completed weeks gestation, underwent ECV in day care ward. Fifteen minutes before the procedure, injection salbutamol 0.25 mg was administered subcutaneously. Cases with contraindication to ECV or Salbutamol injection were excluded from the study. The outcome measures included success rate of ECV [in terms of conversion from breech to cephalic presentation at the completion of procedure confirmed through ultrasound], association of maternal and fetal demographic characteristics with successful version and adverse effects related to the procedure in terms of fetal bradycardia, ante-partum still birth, antepartum hemorrhage and preterm labour. Rate of reversion to breech and drug-related side effects were also recorded as secondary outcome measures. Chi-square test was used for categorical variables and independent sample t-test for continuous variables. Of the 101 ECV procedures, 41 [40.5%] were successful. Success rate was significantly lower in nullipara [p=0.01] and with AFI 7 cm or less [p=0.04]. No significant association was found between success rate and gestational age [p=0.35] or fetal birth weight [p=0.57]. None of the patient suffered from serious maternal complications. Salbutamol related minor effects [tremors, anxiety and palpitations] were observed in 36 [35.6%] patients. Fetal tachycardia was seen in 17 [16.8%], reversible fetal bradycardia in 3 [2.9%] and intractable fetal bradycardia in one patient. External cephalic version with 0.25 mg Salbutamol was safe and a feasible option in term breech presentation in this series. Administration of tocolytic agent improved the success rate and reduced complication rate of the procedure. Major determinants of success were amniotic fluid index and parity

Efficacy of external cephalic version with tocolysis in late pregnancy.

OBJECTIVE: To study the success rate and identify factors influencing the success rate of external cephalic. version (ECV) at Bhumibol Adulyadej Hospital. STUDY DESIGN: Prospective descriptive study. SETTING: Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital. MATERIAL AND METHOD: All parturients attending the obstetrics unit at Bhumibol Adulyadej Hospital between October 1, 1997 and September 30, 2006, having completed 36 or more gestational weeks with singleton non-vertex fetus, who had no exclusion criteria for ECVwere given full information concerning a trial of ECV risk of cesarean section, and risk of emergency breech deliveries. Those who chose to undergo ECV after counseling were recruited and gave signed consent. One hundred and forty singleton, pregnant women with non-vertex presentation participated in this study. RESULTS: The success rate of ECV was 71.43%. Birth weight significantly affected the success rate of ECV Maternal weight, parity, gestational age, and placental site did not have any effect on the outcome. All fetuses in the present study were subsequently delivered without significant morbidity and no cases of perinatal mortality were recorded. CONCLUSION: ECV is a safe procedure with a high success rate in selective cases. ECV thus, is an effective alternative practice for non-vertex presentation, which can also reduce the rate of breech delivery and cesarean section. The major benefits of external cephalic version are reduced maternal morbidity and mortality from surgery.

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

External cephalic version before elective caesarean section for breech presentation

The Royal College of Obstetrics and Gynaecology guidelines state that all uncomplicated breech presentations should be offered external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version before undertaking the procedure. To ascertain the acceptability of external cephalic version before elective caesarean section for breech presentation by pregnant ladies and see whether they were adequately informed about the risks and benefits. The clinical audit was registered with the audit department at Watford general hospital and written consent for the access of medical records was obtained. A retrospectixre review of 86 accessible medical records out of total 110 elective breech caesarean sections was done over a period of one year. January to December 2006. This retrospective study was conducted at the gynaecology and obstetrics department at Watford general hospital, Watford United Kingdom. Written consent for the access of medical records was obtained. All women who underwent elective caesarean section due to breech presentation were included in the study. Out of a total of 110 elective breech caesarean sections performed, the data on 86 cases was selected for the final analysis. The information gathered included patient's profile, whether patient was informed of risks and benefits of external cephalic version, recognition of obstetric risk factors, external cephalic version performed and its success. Out of total 86 caesarean sections 46 were suitable for external cephalic version of whom 37 cases were offered external cephalic version. Among 37 patients who were offered external cephalic version only 15 patients accepted [22 declined] the procedure. Moreover, it was found that the documentation of risk/benefit explanation of the procedure was inadequate. external cephalic version was not successful in any of the patient. Causes for unsuccessful external cephalic version were abdominal discomfort [51, inability to disengage fetus from pelvis [4], fetal bradycardia [3] and uterine irritability [3]. External cephalic version was not successful in any of the cases in this study. However, to reduce the number of elective caesarean sections for breech presentation, external cephalic version should be offered to all women with uncomplicated breech presentation. Continuing medical education, dissemination of guidelines and regular clinical audit are necessary to improve the success rates of external cephalic version

External Cephalic Version Attempted under Epidural Anesthesia : Case reports

Recently, the external cephalic version procedure has attracted attention as an alternative for the operative or vaginal delivery of a breech-presenting fetus. Although this procedure has many benefits, including its comparative safety and economical efficiency, it is not free from complications. We report two cases of external versions attempted under epidural anesthesia. These cases demonstrate that the use of a neuraxial blockade during a version attempt can provide the appropriate conditions necessary for this procedure, as well as the ability to deal with complications in a timely and safe manner.

Rupture of Unscarred Uterus Detected during a Cesarean Section : A case report

Uterine rupture is usually associated with previous uterine scar. Although intrapartum rupture of unscarred uterus is very rare, it may cause catastrophic outcomes to both the mother and the newborn infant compared with that of a scarred uterus. The present case describes our experience of anesthesia for an emergency cesarean section due to the arrest of fetal descent in a 36-year-old parturient who had undergone external cephalic version for the breech presentation of her fetus. We detected the rupture of her unscarred uterus during the operation under epidural anesthesia, which was changed to general anesthesia. Despite the uterine rupture the newborn infant survived uneventfully. At the postoperative twelfth day she was discharged from hospital with her baby.

Maternal, neonatal mortality and morbidity due to obstetrical procedures

Obstetrical procedure is the intervention which is done by the obstetrician to correct the advance of delivery in order to assure a healthy mother and newborn. The obstetrician can intervene by one of the following ways: 1. External and internal version. 2. Vacuum extractor. 3. Delivery forceps. 4., Cesarean session. Bleeding is the most common complication in the delivery without procedure 55.2%.. Pretermission is the most common complication after the delivery without procedure 36%. The bleeding is the most common complication 7.4% after procedure by vacuum extractor. Asphyxia is the most common complication at newborns 8.3% after delivery by vacuum extractor. Mother's morbidity percentage after delivery by forceps is 36%. Newborns' morbidity percentage after delivery by forceps is 18%. Mother's morbidity percentage after internal version of second twin is 17.5%. Newborns' morbidity percentage after internal version of second twin is 54% and the pretermission is the most common complication. Mothers' morbidity percentage after cesarean session is 17.4% and the bleeding is the most common complication. Newborns' morbidity percentage after cesarean session is 19.2% and the pretermission is the most common complication. By this study we conclude that delivery without procedure is the least morbidity for mothers and the forceps is the most morbidity for them, and the cesarean session is the most common reason for bleeding, and the internal version of second twin is the most morbidity and mortality for newborns. Therefore, obstetrician has to adhere the conditions of procedure and choose the right indication due to decrees the morbidity of mothers and newborns

Value and pregnancy outcome of external cephalic version

To determine the efficacy and pregnancy outcome of external cephalic version at >/= 37 weeks gestation, 90 women with a singleton breech fetus in King Hussein Medical Centre who had the procedure were compared with 102 women in a control group in whom the procedure was not attempted. External cephalic version was successfully performed on 59 fetuses [64%]. Caesarean section was performed on 39% of patients who underwent the procedure compared to 61% of the control group. Version was more successful in multiparous than nulliparous women. External cephalic version was effective in reducing the number of caesarean deliveries in term breech infant in different obstetric settings, with no major neonatal adverse outcome

Efforts to reduce caesarean section rate

The objective of present study was to fund out the effectiveness of methods for the reduction of Caesarean section rate [CSR]. It was conducted in Obstetric and Gynaecology Unit II, Bahawal Victoria Hospital, Bahawalpur from January 2001 to December 2001. A total of 3753 patients were admitted during the year 2001 in Gynae Unit II, out of which 2170 were obstetric patients. The total number of vaginal deliveries were 1591 [73.3286] and the total number of caesarean sections were 579 [26.6896]. With external cephalic version [ECM, 87.5 96 success rate was observed in vaginal deliveries. In case of vaginal births after previous Caesarean section the success rate turned out to be 61.3146. Trial of scar, ECV and careful decision about primary Caesarean section significantly reduce the CSR

External cephalic version at Bhumibol Adulyadej Hospital.

To study the success rate and identify the factors influencing the success rate of external cephalic version (ECV) at Bhumibol Adulyadej Hospital. The subjects were seventy-two, singleton, pregnant women with non-vertex presentation who were at least thirty-six weeks of gestation and had attended the antenatal care clinic between October 1,1997 and September 30, 1999. The success rate of ECV was 75.68 per cent. AFI and fetal weight significantly affected the success rate of ECV, other factors did not. Conclusion: ECV is a safe procedure with a high success rate in selective cases. ECV, thus, is an effective alternative practice for non-vertex presentation which can also reduce the rate of breech delivery and cesarean section.