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

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

Evaluación de la versión cefálica externa en el manejo de las distocias de presentación / Evaluation of external cephalic version in the management of presentation dystocia

En un trabajo prospectivo y controlado, realizamos versiones externas bajo tocólisis a un grupo de 45 pacientes con presentaciones podálicas y transversas entre las 36 y 40 semanas de gestación. Obtuvimos un 73 por ciento de éxito en el procedimiento con un 49 por ciento de cesáreas en el grupo de estudio comparado con un 87 por ciento en el grupo control. Los factores más importantes en el resultado fueron el tipo de presentación y la paridad. No observamos complicaciones maternas ni fetales significativas