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Primary study

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A randomized trial of external cephalic version in late pregnancy

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Journal JK Science
Year 2012
Links www.jkscience.org Google Scholar

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To assess the role of external cephalic version (ECV) in late pregnancy. A prospective randomized controlled trial of external cephalic version after 37 weeks gestation. All women, in whom routine ultrasound examination during the 37th week of pregnancy had shown a single breech presentation were eligible for recruitment. Department of Obstetrics & Gynecology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar. 60 women with breech presentation at term were recruited after satisfying eligibility criteria. There were 30 women in study group and 30 in the control group. Intervention - ECV was attempted in study group in dorsal position with left lateral tilt over a maximum period of 5 minutes. Main outcome measures - Success rate in terms of presentation during labour, need for caesarean section and various variables related to foetal outcome.ECV was successful in 24 out of 30 patients (80%). Breech presentation at delivery occurred in 93.3% of the control group and in 20% of the ECV group. The caesarean section rates were 73.3% and 20% respectively. There were no troublesome complications from the procedure.

Primary study

Unclassified

Value and pregnancy outcome of external cephalic version.

Authors Hindawi I
Journal Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ
Year 2005
Links Pubmed Fulltext link

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To determine the efficacy and pregnancy outcome of external cephalic version at > or = 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.

Primary study

Unclassified

The role of external cephalic version on the presentation at delivery.

Authors Dafallah SE , Elhag SM
Journal Saudi medical journal
Year 2004
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External cephalic version at term. A randomized controlled trial using tocolysis.

Authors Mahomed K , Seeras R , Coulson R
Journal British journal of obstetrics and gynaecology
Year 1991
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OBJECTIVE: To assess the role of external cephalic version (ECV) at term, using tocolysis. DESIGN: A randomized controlled trial over a 12 month period. SETTING: Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS: 208 women with breech presentation at term were recruited after satisfying eligibility criteria. There were 103 women in the study group and 105 in the control group. At the end of the study a further 104 women were recruited for ECV. INTERVENTION: ECV attempted after intravenous injection of 10 micrograms of hexaprenaline, using either forward or backward somersault over a maximum period of 5 min. MAIN OUTCOME MEASURES: Success rate in terms of presentation during labour, need for caesarean section, and various variables related to fetal outcome. RESULTS: ECV reduced the frequency of breech presentation during labour from 83% to 17% and that of caesarean section from 33% to 13%. There were no troublesome complications from the procedure. CONCLUSION: In carefully selected women with breech presentation, ECV at term using tocolysis, safely reduced the rate of breech presentation in labour and also the caesarean section rate. Further research is needed to determine the role of ECV in early labour.

Primary study

Unclassified

[The benefit of external version in full-term breech presentation].

Journal Nederlands tijdschrift voor geneeskunde
Year 1990
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We report a randomised controlled trial of external version in 52 women with breech presentation after 36 weeks' gestation; 83% gave informed consent to undergo the management to which they had been randomized. Only 5% of initial attempts without tocolysis succeeded, but 31% of the failures subsequently had a successful version under tocolysis. External version resulted in a small decrease in the frequency of breech presentation at birth (64% vs. 74%), and in an unexpected increase in the caesarean section rate (28% vs. 11%). The increase in caesarean section rate could be attributed to failed versions, which apparently greatly influenced the choice between abdominal and vaginal delivery. Our findings and data from similar research suggest that benefits of external version at term may not apply to populations with a low caesarean rate, unless versions are carried out with maximal efficiency (which, on the basis of available data, would imply tocolysis) or so indifferently that failed attempts do not influence the choice between abdominal and vaginal delivery.

Primary study

Unclassified

Value of external version in breech presentation at term

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Journal Nederlands Tijdschrift voor Geneeskunde
Year 1990
Links www.ntvg.nl

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We report a randomised controlled trial of external version in 52 women with breech presentation after 36 weeks‘ gestation; 83 gave informed consent to undergo the management to which they had been randomized. Only 5 of initial attempts withou tocolysis succeeded, but 31 of the failures subsequently had successful version under tocolysis. External version resulted in a small decrease in the frequency of breech presentation at birth (64 vs. 74), and in an unexpected increase in the caesarean section rate (28 vs. 11). The increase in caesarean section rate could be attributed to failed versions, which apparently greatly influenced the choice between abdominal and vaginal delivery. Our findings and data from similar research suggest that benefits of external version at term may not apply to populations with a low caesarean rate, unless versions are carried out with maximal efficiency (which, on the basis of available data, would imply tocolysis) or so indifferently that failed attempts do not influence the choice between abdominal and vaginal delivery.

Primary study

Unclassified

A randomized trial of external cephalic version with tocolysis in late pregnancy.

Authors Brocks V , Philipsen T , Secher NJ
Journal British journal of obstetrics and gynaecology
Year 1984
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The effect of external version under tocolysis with intravenous ritodrine during the 37th week of gestation was studied in a prospective randomized trial comprising 130 consecutive women with a fetus in breech presentation. Version was successful in 41% of the patients, all of whom had a cephalic vaginal delivery. Of the 56 women in the control group in whom version was not attempted; 8 (14%) converted to the vertex presentation spontaneously. Failure of version was significantly correlated with primiparity, location of the placenta on the anterior uterine wall, and maternal weight. The caesarean section rate was significantly lower in the version group (27%) than in the control group (46%) (P less than 0.05). The overall caesarean section rate for a fetus in breech presentation was 50%. There were no serious complications associated with version and the condition of the infants at birth was better in the version group than in the control group. We advise external version under tocolysis in late pregnancy to reduce the frequency of breech presentation in labour.

Primary study

Unclassified

Effect of external cephalic version in late pregnancy on breech presentation and caesarean section rate: a controlled trial.

Authors Hofmeyr GJ
Journal British journal of obstetrics and gynaecology
Year 1983
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A prospective randomized controlled trial of external cephalic version (ECV) in late pregnancy is reported. All pregnancies were assessed with ultrasound and cardiotocography. ECV was successful in 29 out of 30 patients (97%). Breech presentation at delivery occurred in 67% of the control group and in 3% of the ECV group. The caesarean section rates were 43 and 20% respectively. Tocolysis was used in seven patients. A new technique of ECV with the steep lateral position is described. Complications were limited to cardiotocographic changes and one patient with unexplained vaginal spotting. The procedure is recommended provided appropriate patient selection and surveillance is practised.

Primary study

Unclassified

Randomized control trial of external cephalic version with tocolysis in late pregnancy.

Journal American journal of obstetrics and gynecology
Year 1981
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Two strategies have evolved for managing term intrapartum breech presentation: routine cesarean section and selective vaginal delivery. Both result in an exceedingly high cesarean section rate and neither attacks the frequency of breech presentation in labor. External cephalic version under tocolysis (ECV-T) offers an altemative. In a randomized, controlled trial, we tested ECV-T (terbutaline) at 37 to 39 weeks' gestation on 51 low-risk patients. Normal real time B-scan examination and reactive nonstress test were prerequisites. Rigid exciusion criteria were employed. Version succeeded in 68% of the attempts and all presented in labor with a vertex presentation. All those in whom version falled (32%) presented in labor with a breech presentation and 75% were delivered by cesarean section. Nulliparity, maternal obesity, engagement of the breech, and uterine anomaly prejudiced success. In the control group (version not attempted), 18% converted spontaneously to vertex while 82% persisted with a breech presentation. Despite a liberal policy concerning vaginal breech delivery, 85% of the patients (entire series) with breech presentation during labor were delivered by cesarean section. Transient fetal heart rate (FHR) deceleration was noted during version in 36% of the attempts (24% of successes and 63% of failures) but invariably responded when manipulation ceased. However, fetal distress immediately following successful version necessitated intervention in one patient who ultimately had a normal labor and vaginal delivery of a healthy infant. There were no other untoward maternal, fetal, or neonatal complications and outcome was uniformly good. These preliminary data suggest that ECV-T late in pregnancy reduces (p < 0.01) the incidence of intrapartum breech presentation. The effect on the cesarean section rate depends on the strategy for management of the breech presentation. Uterine relaxants appear to facilitate the procedure. Although we experienced no adverse outcomes, larger series are required to determine safety of ECV-T.