To determine the rate of success of external cephalic version in low risk breech presentations and possible factors affecting its success in POF hospital, Wah Cantt.

  • Noreen Majeed Wah medical college
  • Shabana Kalsoom
  • Faiza Safdar
  • Shazia Rafique
  • Shamsa Tariq
  • Saana Bibi
Keywords: External cephalic version, factors affecting success of external cephalic version

Abstract

Abstract

 

Background

The caesarean section rate  is on the rise for various reasons. One of the reason is breech presentation . External cephalic version is a procedure to manipulate the baby from breech to cephalic presentation externally through the maternal abdomen under USG guidance . Success in ECV decreases the breech presentation and  hence caesarean section rate .

Methods

This retrospective study was conducted by Wah Medical College in POF hospital from10 Oct 2015- 10 Oct 2019 after approval from the ethical committee .

 It included 56 low risk singleton  breech presentations from 36 wks- 40 wks after taking their informed consent  While those with < than 36 wks (primis) and >40 wks gestation, refusal to ECV , with absolute contraindication to ECV& with medical and obstetric complications (ie scarred uterus, liquor <than 8 cm & > than 17 cm, fetal growth restriction, preclampsia, gestational diabetes & abnormal cardiotocography) were excluded  from the study. ECV was performed by single obstetrician in labour room with facilities  of cardiotocograph and emergency caesarean section. Cardiotocography of the fetus  for 30-40 min was done just before & after the procedure of ECV. ECV was declared successful on cofirming head of the fetus occupying the lower uterine segment on ultrasound.  .Number  of successful ECVs & specific factors  of the women & the baby (age . parity, amniotic fluid index ,type of breech, engagement of breech, position of back of baby)  were chosen to observe their effect on success of  ECV.

Results

External cephalic version was successful in 27 (48.2%)  & unsuccessful in 29 (51.8%)of women .Multiparity , unengaged breech & type of breech (complete flexed) ( with p values .001, .000 & .001 respectively) had statistically significant positive association with successful external cephalic version.

Conclusion

ECV should be offered to all  women with low risk breech presentations. Knowledge of factors predictive of ECV success can be utilized in selecting cases for ECV &counselling the women regarding the success and failure of ECV.

 

 

References

1. Hickok DE, Gordon DC, Milberg JA, Williams MA, Daling JR. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol. 1992 Mar. 166(3):851-2.

2.. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR, Collaborative TB. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. The Lancet. 2000 Oct 21;356(9239):1375-83.
3. Luthringer M, Marziale J, Done WI, Works HW. External Cephalic Version (Version) for Breech Position. ACOG Practice Bulletin No. 13. Obstetrics andGynecology, 2000, reaffirmed,2012).95(2): 1-7.
4. Thomas J, Paranjothy S. The national sentinel caesarean section audit report. National Sentinel Caesarean Section Audit Report. RCOG Press .2001.

5. Impey LW, Murphy DJ, Griffiths M, Penna LK. On behalf of the Royal College of Obstetricians and Gynaecologists. external cephalic version and reducing the incidence of term breech presentation. BJOG. 2017;124:e178-92.

6. Rodgers R, Beik N, Nassar N, Brito I, de Vries B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Apr 1;124(5):767-72.

7.Rauf B, Karim R. SUCCESS OF EXTERNAL CEPHALIC VERSION WITH TERBUTALINE AS TOCOLYTIC AGENT. Khyber Medical University Journal. 2017 Jul 1;9(3).


8. Kew N, DuPlessis J, La Paglia D, Williams K. Predictors of cephalic vaginal delivery following external cephalic version: an eight-year single-centre study of 447 cases. Obstetrics and Gynecology International. 2017 Jan 1;2017.


9 . Bogner G, Wallner V, Fazelnia C, Strobl M, Volgger B, Fischer T, Jacobs VR. Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study. BMC pregnancy and childbirth. 2018 Dec 1;18(1):176.


10. Rosman AN, Guijt A, Vlemmix F, Rijnders M, Mol BW, Kok M. Contraindications for external cephalic version in breech position at term: a systematic review. Acta obstetricia et gynecologica Scandinavica. 2013 Feb;92(2):137-42.



11. Shanahan MM, Gray CJ. External Cephalic Version. InStatPearls [Internet] 2020 Feb 10. StatPearls Publishing.


12 .Ducarme G. Breech Presentation: CNGOF Guidelines for Clinical Practice-External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation. Gynecologie, Obstetrique, Fertilite & Senologie. 2019 Oct 31;48(1):81-94.


13. Lerner HM. External cephalic version: How to increase the chances for success.
OBG Manag. 2017 September;29(9):26, 28-32

14. American College of Obstetricians and Gynecologists. Practice Bulletin No. 161: External Cephalic Version. Obstetrics and gynecology. 2016 Feb;127(2):e54.

15. Edmonds DK, Lees C, Bourne T, editors. Malpresentation, Malposition ,Cephalopelvic Disproportion and Obsteric Procedures .Dewhurst's textbook of Obstetrics & Gynaecology. Oxford, UK: John Wiley & Sons Ltd, 2018; Chap 26,p.354–71.

16.. Kenny LC, Myers JE, editors. Obstetrics by ten teachers. CRC Press; 20 th edition, 2017 May 18.


17. Bewley S, Robson SC, Smith M, Glover A, Spencer JA. The introduction of external cephalic version at term into routine clinical practice. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1993 Dec 15;52(2):89-93.



18. Hussin OA, Mahmoud MA, Abdel Fattah MM. External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section. EMHJ-Eastern Mediterranean Health Journal, 19 (2), 162-166, 2013. 2013.


19.Deepika N,et al . External cephalic version at 36 weeks and its outcome. Int J Reprod Contracept Obstet Gynecol,2017 Oct;6 (10);4602-4607.


20. Silva RM, Clode N. Applying the Newman-Peacock prognostic system to a Portuguese obstetrical population-A useful tool?. Revista Brasileira de Ginecologia e Obstetricia. 2018 Jan;40(1):4-10.



21 . Rodgers R, Beik N, Nassar N, Brito I, de Vries B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Apr 1;124(5):767-72.


22. Sadia S, Rizwan S, Sultana S, Waqar F, Rauf R, Owais S. External Cephalic Version (ECV) for Breech Presentation at Term-Experience at Railway Hospital. JIIMC JOURNAL OF ISLAMIC INTERNATIONAL MEDICAL COLLEGE.:8.


23. Newman RB, Peacock BS, VanDorsten JP, Hunt HH. Predicting success of external cephalic version. American journal of obstetrics and gynecology. 1993 Aug 1;169(2):245-50.


24. Isakov O, Reicher L, Lavie A, Yogev Y, Maslovitz S. Prediction of success in external cephalic version for breech presentation at term. Obstetrics & Gynecology. 2019 May 1;133(5):857-66.


25.. Tasnim N, Mahmud G, Javaid K, Malhotra N, Puri R. GNK-PIMS Score: a predictive model for success of external cephalic version. J South Asian Fed Obstet Gynaecol. 2012 May;4(02):99-102.


26. Burgos J, Cobos P, Rodriguez L, PIJOÁN JI, FERNÁNDEZ‐LLEBREZ L, MARTÍNEZ‐ASTORQUIZA T, MELCHOR JC. Clinical score for the outcome of external cephalic version: A two‐phase prospective study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2012 Feb;52(1):59-61.





















1. Hickok DE, Gordon DC, Milberg JA, Williams MA, Daling JR. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol. 1992 Mar. 166(3):851-2.

2.. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR, Collaborative TB. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. The Lancet. 2000 Oct 21;356(9239):1375-83.
3. Luthringer M, Marziale J, Done WI, Works HW. External Cephalic Version (Version) for Breech Position. ACOG Practice Bulletin No. 13. Obstetrics andGynecology, 2000, reaffirmed,2012).95(2): 1-7.
4. Thomas J, Paranjothy S. The national sentinel caesarean section audit report. National Sentinel Caesarean Section Audit Report. RCOG Press .2001.

5. Impey LW, Murphy DJ, Griffiths M, Penna LK. On behalf of the Royal College of Obstetricians and Gynaecologists. external cephalic version and reducing the incidence of term breech presentation. BJOG. 2017;124:e178-92.

6. Rodgers R, Beik N, Nassar N, Brito I, de Vries B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Apr 1;124(5):767-72.

7.Rauf B, Karim R. SUCCESS OF EXTERNAL CEPHALIC VERSION WITH TERBUTALINE AS TOCOLYTIC AGENT. Khyber Medical University Journal. 2017 Jul 1;9(3).


8. Kew N, DuPlessis J, La Paglia D, Williams K. Predictors of cephalic vaginal delivery following external cephalic version: an eight-year single-centre study of 447 cases. Obstetrics and Gynecology International. 2017 Jan 1;2017.


9 . Bogner G, Wallner V, Fazelnia C, Strobl M, Volgger B, Fischer T, Jacobs VR. Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study. BMC pregnancy and childbirth. 2018 Dec 1;18(1):176.


10. Rosman AN, Guijt A, Vlemmix F, Rijnders M, Mol BW, Kok M. Contraindications for external cephalic version in breech position at term: a systematic review. Acta obstetricia et gynecologica Scandinavica. 2013 Feb;92(2):137-42.



11. Shanahan MM, Gray CJ. External Cephalic Version. InStatPearls [Internet] 2020 Feb 10. StatPearls Publishing.


12 .Ducarme G. Breech Presentation: CNGOF Guidelines for Clinical Practice-External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation. Gynecologie, Obstetrique, Fertilite & Senologie. 2019 Oct 31;48(1):81-94.


13. Lerner HM. External cephalic version: How to increase the chances for success.
OBG Manag. 2017 September;29(9):26, 28-32

14. American College of Obstetricians and Gynecologists. Practice Bulletin No. 161: External Cephalic Version. Obstetrics and gynecology. 2016 Feb;127(2):e54.

15. Edmonds DK, Lees C, Bourne T, editors. Malpresentation, Malposition ,Cephalopelvic Disproportion and Obsteric Procedures .Dewhurst's textbook of Obstetrics & Gynaecology. Oxford, UK: John Wiley & Sons Ltd, 2018; Chap 26,p.354–71.

16.. Kenny LC, Myers JE, editors. Obstetrics by ten teachers. CRC Press; 20 th edition, 2017 May 18.


17. Bewley S, Robson SC, Smith M, Glover A, Spencer JA. The introduction of external cephalic version at term into routine clinical practice. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1993 Dec 15;52(2):89-93.



18. Hussin OA, Mahmoud MA, Abdel Fattah MM. External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section. EMHJ-Eastern Mediterranean Health Journal, 19 (2), 162-166, 2013. 2013.


19.Deepika N,et al . External cephalic version at 36 weeks and its outcome. Int J Reprod Contracept Obstet Gynecol,2017 Oct;6 (10);4602-4607.


20. Silva RM, Clode N. Applying the Newman-Peacock prognostic system to a Portuguese obstetrical population-A useful tool?. Revista Brasileira de Ginecologia e Obstetricia. 2018 Jan;40(1):4-10.



21 . Rodgers R, Beik N, Nassar N, Brito I, de Vries B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Apr 1;124(5):767-72.


22. Sadia S, Rizwan S, Sultana S, Waqar F, Rauf R, Owais S. External Cephalic Version (ECV) for Breech Presentation at Term-Experience at Railway Hospital. JIIMC JOURNAL OF ISLAMIC INTERNATIONAL MEDICAL COLLEGE.:8.


23. Newman RB, Peacock BS, VanDorsten JP, Hunt HH. Predicting success of external cephalic version. American journal of obstetrics and gynecology. 1993 Aug 1;169(2):245-50.


24. Isakov O, Reicher L, Lavie A, Yogev Y, Maslovitz S. Prediction of success in external cephalic version for breech presentation at term. Obstetrics & Gynecology. 2019 May 1;133(5):857-66.


25.. Tasnim N, Mahmud G, Javaid K, Malhotra N, Puri R. GNK-PIMS Score: a predictive model for success of external cephalic version. J South Asian Fed Obstet Gynaecol. 2012 May;4(02):99-102.


26. Burgos J, Cobos P, Rodriguez L, PIJOÁN JI, FERNÁNDEZ‐LLEBREZ L, MARTÍNEZ‐ASTORQUIZA T, MELCHOR JC. Clinical score for the outcome of external cephalic version: A two‐phase prospective study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2012 Feb;52(1):59-61.
























1. Hickok DE, Gordon DC, Milberg JA, Williams MA, Daling JR. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol. 1992 Mar. 166(3):851-2.

2.. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR, Collaborative TB. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. The Lancet. 2000 Oct 21;356(9239):1375-83.
3. Luthringer M, Marziale J, Done WI, Works HW. External Cephalic Version (Version) for Breech Position. ACOG Practice Bulletin No. 13. Obstetrics andGynecology, 2000, reaffirmed,2012).95(2): 1-7.
4. Thomas J, Paranjothy S. The national sentinel caesarean section audit report. National Sentinel Caesarean Section Audit Report. RCOG Press .2001.

5. Impey LW, Murphy DJ, Griffiths M, Penna LK. On behalf of the Royal College of Obstetricians and Gynaecologists. external cephalic version and reducing the incidence of term breech presentation. BJOG. 2017;124:e178-92.

6. Rodgers R, Beik N, Nassar N, Brito I, de Vries B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Apr 1;124(5):767-72.

7.Rauf B, Karim R. SUCCESS OF EXTERNAL CEPHALIC VERSION WITH TERBUTALINE AS TOCOLYTIC AGENT. Khyber Medical University Journal. 2017 Jul 1;9(3).


8. Kew N, DuPlessis J, La Paglia D, Williams K. Predictors of cephalic vaginal delivery following external cephalic version: an eight-year single-centre study of 447 cases. Obstetrics and Gynecology International. 2017 Jan 1;2017.


9 . Bogner G, Wallner V, Fazelnia C, Strobl M, Volgger B, Fischer T, Jacobs VR. Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study. BMC pregnancy and childbirth. 2018 Dec 1;18(1):176.


10. Rosman AN, Guijt A, Vlemmix F, Rijnders M, Mol BW, Kok M. Contraindications for external cephalic version in breech position at term: a systematic review. Acta obstetricia et gynecologica Scandinavica. 2013 Feb;92(2):137-42.



11. Shanahan MM, Gray CJ. External Cephalic Version. InStatPearls [Internet] 2020 Feb 10. StatPearls Publishing.


12 .Ducarme G. Breech Presentation: CNGOF Guidelines for Clinical Practice-External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation. Gynecologie, Obstetrique, Fertilite & Senologie. 2019 Oct 31;48(1):81-94.


13. Lerner HM. External cephalic version: How to increase the chances for success.
OBG Manag. 2017 September;29(9):26, 28-32

14. American College of Obstetricians and Gynecologists. Practice Bulletin No. 161: External Cephalic Version. Obstetrics and gynecology. 2016 Feb;127(2):e54.

15. Edmonds DK, Lees C, Bourne T, editors. Malpresentation, Malposition ,Cephalopelvic Disproportion and Obsteric Procedures .Dewhurst's textbook of Obstetrics & Gynaecology. Oxford, UK: John Wiley & Sons Ltd, 2018; Chap 26,p.354–71.

16.. Kenny LC, Myers JE, editors. Obstetrics by ten teachers. CRC Press; 20 th edition, 2017 May 18.


17. Bewley S, Robson SC, Smith M, Glover A, Spencer JA. The introduction of external cephalic version at term into routine clinical practice. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1993 Dec 15;52(2):89-93.



18. Hussin OA, Mahmoud MA, Abdel Fattah MM. External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section. EMHJ-Eastern Mediterranean Health Journal, 19 (2), 162-166, 2013. 2013.


19.Deepika N,et al . External cephalic version at 36 weeks and its outcome. Int J Reprod Contracept Obstet Gynecol,2017 Oct;6 (10);4602-4607.


20. Silva RM, Clode N. Applying the Newman-Peacock prognostic system to a Portuguese obstetrical population-A useful tool?. Revista Brasileira de Ginecologia e Obstetricia. 2018 Jan;40(1):4-10.



21 . Rodgers R, Beik N, Nassar N, Brito I, de Vries B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Apr 1;124(5):767-72.


22. Sadia S, Rizwan S, Sultana S, Waqar F, Rauf R, Owais S. External Cephalic Version (ECV) for Breech Presentation at Term-Experience at Railway Hospital. JIIMC JOURNAL OF ISLAMIC INTERNATIONAL MEDICAL COLLEGE.:8.


23. Newman RB, Peacock BS, VanDorsten JP, Hunt HH. Predicting success of external cephalic version. American journal of obstetrics and gynecology. 1993 Aug 1;169(2):245-50.


24. Isakov O, Reicher L, Lavie A, Yogev Y, Maslovitz S. Prediction of success in external cephalic version for breech presentation at term. Obstetrics & Gynecology. 2019 May 1;133(5):857-66.


25.. Tasnim N, Mahmud G, Javaid K, Malhotra N, Puri R. GNK-PIMS Score: a predictive model for success of external cephalic version. J South Asian Fed Obstet Gynaecol. 2012 May;4(02):99-102.


26. Burgos J, Cobos P, Rodriguez L, PIJOÁN JI, FERNÁNDEZ‐LLEBREZ L, MARTÍNEZ‐ASTORQUIZA T, MELCHOR JC. Clinical score for the outcome of external cephalic version: A two‐phase prospective study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2012 Feb;52(1):59-61.
Published
2021-06-30
How to Cite
1.
Majeed N, Kalsoom S, Safdar F, Rafique S, Tariq S, Bibi S. To determine the rate of success of external cephalic version in low risk breech presentations and possible factors affecting its success in POF hospital, Wah Cantt. JRMC [Internet]. 30Jun.2021 [cited 4Dec.2021];25(2):186-91. Available from: http://www.journalrmc.com/index.php/JRMC/article/view/1507
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