Contribution of changing risk factors to the trend in breech presentation at term.

BACKGROUND: Recent population-wide changes in perinatal risk factors may affect rates of breech presentation at birth, and have implications for the provision of breech services and training in breech management. AIMS: To investigate whether changes in maternal and pregnancy characteristics explain the observed trend in breech presentation at term. MATERIALS AND METHODS: All singleton term (≥37 week) births in New South Wales during 2002-2012 were identified through birth and associated hospital records. Annual rates of breech presentation were determined. Logistic regression modelling was used to predict expected rates of breech presentation and these were compared with observed rates over time. A priori predictors included maternal age, country of birth, parity, smoking during pregnancy, diabetes, pregnancy hypertension, placenta praevia, previous singleton term breech, previous caesarean section, infant sex, gestational age, birthweight and congenital anomalies. Hospital and Medicare data were used to assess concomitant trends in external cephalic version. RESULTS: Among 914 147 singleton term births, 3.1% were breech at delivery. Rates of breech presentation declined from 3.6% in 2002 to 2.7% in 2012 (test for trend P < 0.001), but was predicted to increase from 3.6% in 2002 to 4.3% in 2012 because of increased maternal age, nulliparity, maternal diabetes, history of breech presentation and previous caesarean section. However, use of external cephalic version appears to have increased over time. CONCLUSIONS: Breech presentation at delivery has decreased in New South Wales. Increased use of external cephalic version likely accounts for this decline, as changes in risk factors do not.

External cephalic version for singleton breech presentation: proposal of a practical check-list for obstetricians.

OBJECTIVE: External cephalic version (ECV) for breech presentation is not routinely performed by obstetricians in many clinical settings. The aim of this work is to assess to what extent the factors involved in performing ECV are relevant for the success and safety of ECV, in order to propose a practical check-list for assessing the feasibility of ECV. METHODS: Review of 214 references. Factors involved in the success and risks of ECV (feasibility of ECV) were extracted and were scored in a semi-quantitative way according to textual information, type of publication, year of publication, number of cases. Simple conjoint analysis was used to describe the relevance found for each factor. RESULTS: Parity has the pivotal role in ECV feasibility (relevance 16.6%), followed by tocolysis (10.8%), gestational age (10.6%), amniotic fluid volume (4.7%), breech variety (1.9%), and placenta location (1.7%). Other factors with estimated relevance around 0 (regional anesthesia, station, estimated fetal weight, fetal position, obesity/BMI, fetal birth weight, duration of manoeuvre/number of attempts) have some role in the feasibility of ECV. Yet other factors, with negative values of estimated relevance, have even less importance. CONCLUSIONS: From a logical interpretation of the relevance of each factor assessed, ECV should be proposed with utmost prudence if a stringent check-list is followed. Such a check-list should take into account: parity, tocolytic therapy, gestational age, amniotic fluid volume, breech variety, placenta location, regional anesthesia, breech engagement, fetal well-being, uterine relaxation, fetal size, fetal position, fetal head grasping capability and fetal turning capability.

How singleton breech babies at term are born in France: a survey of data from the AUDIPOG network.

Based on data from the AUDIPOG sentinel network between 1994 and 2010, we can say that the rate of singleton breech presentation at term is 3% and remains unchanged despite an external cephalic version rate of 35%. The total cesarean section rate is currently 75%. This rate increased by nearly 20% after the Hannah publication in 2000, regardless of the type of breech and type of maternity unit. The rate of planned cesarean sections increased in particular, going from 40% to 60%, and even reaching 67% for footling breech presentations. The rate is higher in type I maternity units than in type II or III. This cesarean section rate has been stable since 2005 and has even decreased for the Frank breech. The average rate of external cephalic version remains stable at around 23%. The episiotomy rate is 28%. The rate of babies transferred to neonatology units is higher for breech babies at term than for babies presenting cephalically (3.9% compared to 2.9%), but the newborns most often transferred are those born by cesarean section (4.1% compared to 3.4%).

Recuperación del parto vaginal de nalgas y versión cefálica externa / Reintroduction of vaginal breech delivery and external cephalic version

Objetivo. Se analizan retrospectivamente los resultados obstétricos y neonatales de la aplicación de un protocolo de parto vaginal de nalgas tras 10 años de su abandono. Métodos. Las pacientes eran derivadas a una unidad específica en la semana 36 donde se les ofrecía una versión cefálica externa. Si la presentación de nalgas persistía, eran seleccionadas para intento de parto vaginal si cumplían los siguientes criterios: a) peso fetal estimado 2.500-3.600g; b) nalgas puras o completas; c) cabeza fetal no hiperextendida, y d) pelvis clínicamente adecuada. El progreso del parto requería: a) primer estadio ≥1cm/h; b) segundo estadio 90 min para el descenso pasivo de las nalgas y una hora de pujos activos, y c) se estableció la disponibilidad de experto localizado. Resultados. Se encontró a 93 pacientes con presentación de nalgas única y viva tras la aplicación de la versión cefálica externa. En 69 (73,4%) se indicó una cesárea electiva, y 24 (26,6%) fueron candidatas para parto vaginal, 19 de las cuales lo lograron (20,1%). La tasa de cesáreas por esta indicación se redujo significativamente del 5,7% en 2009 a 2,02% (p<0,001). No se observó ningún resultado fetal adverso (muerte fetal, test de Apgar<7 en 5 min, pH de la arteria umbilical < 7 o traumatismos fetales). Conclusiones. El cumplimiento de los criterios anteparto e intraparto y la disponibilidad de expertos localizados hacen posible un parto vaginal seguro. La aplicación combinada de versión e intento de parto vaginal reduce la tasa de cesáreas por presentación de nalgas(AU)

Objective: To review the obstetric and neonatal outcomes of the application of an updated vaginal breech delivery protocol 10 years after this practice had been discontinued. Methods: Breech presentations were referred to a dedicated breech unit at 36 weeks where the external cephalic version was offered. If breech presentation persisted, the patients were selected to undergo attempted vaginal delivery if the following criteria were met: a) estimated fetal weight of 2.500-3.600 g; b) frank or complete breech presentation; c) absence of hyperextension of the fetal head; and d) a clinically adequate pelvis. Intrapartum criteria included: a) progression of labor of 1 cm/hour in the first hour; b) In the second stage, 90 minutes were allowed for adequate descent of the breech, and 1 hour of active pushing, and c) the availability of an on-call expert. Results: A total of 93 patients showed single live pregnancies in breech presentation after external cephalic version. Sixty-nine patients (73.4%) underwent elective prelabor cesarean delivery, and 24 (26.6%) progressed to attempted vaginal breech delivery, which was successful in 19 (20.1%). Cesarean indications for breech presentation were reduced from 5.7% in 2009 to 2.02% after the application of external cephalic version and vaginal breech delivery (P<.001). We observed no fetal deaths, no Apgar test at 5 minutes of less than 7, no umbilical artery pH of less than 7, and no fetal injuries. Conclusions: . When antepartum and intrapartum criteria are met, vaginal breech delivery is safe. The availability of an on-call expert allows vaginal breech delivery to be safely performed. The combination of external cephalic version and vaginal breech delivery decreases the cesarean rate for breech presentation(AU)

Análisis de los factores que influyen en la aparición de efectos adversos en la versión cefálica externa / Analysis of factors influencing the development of adverse effects in the external cephalic version

Objetivos. Establecer la relación existente entre los efectos adversos de la versión cefálica externa (VCE) y diferentes variables relacionadas con la técnica. Material y método. Estudio prospectivo que incluyó a 180 gestantes a las que se realizó una VCE. Analizamos los efectos adversos fetales y maternos observados, y su relación con el resultado final de la versión, la experiencia del obstetra, el tiempo empleado en la maniobra, el número de intentos realizados en la misma sesión y el fármaco empleado como relajante uterino. Resultados. Se obtuvo el éxito de la VCE en el 32,6% de las primíparas y en el 79,19% en multíparas. La tasa global de efectos adversos fue del 28,33%, y fue superior en las versiones que fracasaron, en las de mayor número de intentos fallidos, las de mayor duración de la maniobra y en las que fue utilizado ritodrina como útero-relajante. Conclusiones. Se obtiene una mayor probabilidad de éxito y una menor tasa de efectos adversos en las VCE en las que se realiza un único intento, con una duración total de la maniobra inferior a 5min y empleando salbutamol como relajante uterino(AU)

Objectives. To identify the association between the adverse effects of the external cephalic version (ECV) and several variables related to the technique. Material and method. We performed a prospective study in 180 pregnant women who delivered through the ECV. We analyzed fetal and maternal adverse effects and their association with the final result of the version, the experience of the obstetrician, the time used in the maneuver, the number of attempts performed in the same session, and the drug used as a uterine relaxant. Results. The ECV was successfully performed in 32.6% of primiparas and 79.19% of multiparas. The overall rate of adverse effects was 28.33%, and was higher in versions that failed, those with a greater number of failed attempts, those with longer duration and those in which ritodrine was used as a uterine relaxant. Conclusions. The factors increasing the probability of success and reducing the rate of adverse effects in ECV are a single attempt at the maneuver, total duration of the maneuver of less than 5minutes, and use of salbutamol as a uterine relaxant(AU)

External cephalic version. Does it have a role in modern obstetric practice?

External cephalic version (ECV) for breech presentation at term substantially reduces the incidence of breech birth and cesarean section. Appropriate counseling and surveillance is important to ensure an acceptably low complication rate and reduce potential for litigation. Even a high success rate for ECV only minimally reduces the overall cesarean section rate.