Fetal movements affect the outcome of external cephalic version under no anesthesia for term breech presentation in full-term singleton pregnancy / 中华围产医学杂志

ABSTRACT

Objective:To investigate the effect of fetal movements on the outcome of external cephalic version (ECV) for breech presentation when performed under no anesthesia in full-term singleton pregnancies.Methods:Totally 126 singleton pregnant women with breech presentations in Yantaishan Hospital of Yantai between March 2015 and March 2019 were retrospectively enrolled. All subjects received ECV without intraspinal anesthesia at 37 full gestational weeks. According to fetal movement status during ECV, the 126 women were divided into fetal movement group ( n=48), including 15 primiparas and 33 multiparas, who underwent ECV during the period of active fetal movement, and control group ( n=78), including 20 primiparas and 58 multiparas, who had ECV performed when the fetus was not actively moving. The success rate of ECV, delivery mode and incidence of maternal and fetal/neonatal complications such as premature rupture of membranes and fetal distress were compared among different groups using Chi-square or Fisher's exact test. Results:The overall success rate of ECV was 61.1%(77/126), and that in the fetal movement group was higher than that in control [77.1%(37/48) vs 51.3%(40/78), χ2=8.323, P=0.004]. The cesarean section rate in the fetal movement group was significantly lower than in control [33.3%(16/48) vs 53.8%(42/78), χ2=5.033, P=0.025]. There were two (4.2%) cases in the fetal movement group and five (6.4%) in the control group reverted to breech position spontaneously after ECV without a statistical difference ( χ2=0.352, P=0.553). There was no statistically significant difference in ECV success rate and cesarean section rate of primiparas between the fetal movement and the control group [9/15 vs 35.0%(7/20), P=0.182; 8/15 vs 75.0%(15/20), P=0.282], while the ECV success rate of multiparas in the fetal movement group was significantly higher than in control [84.8%(28/33) vs 56.9%(33/58), χ2=7.436, P=0.006], while the cesarean section rate was lower [24.2%(8/33) vs 46.6%(27/58), χ2=4.423, P=0.035]. The maternal and infant outcomes in both groups were good, and no placental abruption, umbilical cord prolapse or neonatal asphyxia was reported. For the incidence of intraoperative and postoperative fetal heart abnormality, fetal distress and premature rupture of membranes, no significant difference was found between the fetal movement group and control group [12.5%(6/48) vs 11.5%(9/78), χ2=0.026, P=0.871; 4.1%(2/48) vs 3.8%(3/78), P>0.999; 4.1%(2/48) vs 6.4%(5/78), χ2=0.018, P=0.894]. Conclusions:For full-term breech singleton pregnant women, ECV performed under no anesthesia and active fetal movement may improve the success rate without increasing the risk of maternal and infant complications, especially in multipara.