MyMedR

Fulltext Introducing routine external cephalic version for the management of the malpresenting fetus near term

Devendra K

Med J Malaysia, 2002 Dec;57(4):454-9.

The aim of this study was to assess the efficacy and safety of external cephalic version (ECV) when its use was introduced in the routine management of breech presentation and transverse lie after 36 weeks by obstetricians with limited prior experience with the procedure. The influence of various factors on the outcome of ECV was also studied.

Matched MeSH terms: Breech Presentation*

Outcome of external cephalic version: our experience

Teoh T

J Obstet Gynaecol Res, 1996 Aug;22(4):389-94.

PMID: 8870425

The aim is to assess the outcome of external cephalic version (ECV) for term breech in our clinical setting and the factors involved. Patients with no contraindications and who consented to ECV were recruited into this prospective study. Terbutalin infusion was used. There were 42 ECV attempts of which 21 (50%) were successful. Seventeen of the patients with successful ECV delivered vaginally and 4 had cesarean section for various indications. Only 5 of the 21 unsuccessful ECV delivered vaginally. Thirteen had elective cesarean section and 2 had emergency cesarean during trial of breech. One patient from the unsuccessful ECV group was lost to follow-up. There were 31 (74%) primipara. The birth weight of the babies was not a significant factor in the outcome of ECV. The type of breech and parity did influence the success rate. External cephalic version should be included in the routine management of our breech presentation.

Matched MeSH terms: Breech Presentation*

Term breech trial and its consequences on practice:a retrospective study of the University of Malaya Medical Centre's experience

Noor Azmi MA, Aniza A

JUMMEC, 2005;8:39-44.

To see the trend in managing singleton breech pregnancy after the term breech trial. Secondly to compare the safety of different modes of delivery for term, singleton breeches by looking at the immediate neonatal outcome, based on our own experience. Breech infants were identified by examining computer-stored maternal discharge records of hospitalization for the years 1990 and 2000 respectively. Parameters studied included planned mode of delivery, actual mode of delivery, parity, previous vaginal delivery, Apgar score at five minute, birth weight, referral to special care nursery and neonatal morbidity. Of 6,496 deliveries in 1990 and 5,081 in 2000, there were 220 (3.4%) and 148 (2.9%) term breech infants respectively, of which 115 (for 1990) and 102 (for 2000) case records were available. In 1990, 62.6% of the women had trial of vaginal breech delivery but only 24.5% of the women in 2000 were allowed to do so (p < 0.05). Caesarean section rate for singleton breeches increased from 51.3% in 1990 to 84.3% in 2000 (p < 0.05). Mean Apgar score at five minutes was significantly lower after vaginal breech delivery (9.40 ± 1.36) compared to after Caesarean section (9.72 ± 0.712) but there was no clinical significance. There was a noticeable trend towards Caesarean section and less trial of vaginal delivery. Neonatal outcomes of babies born abdominally were statistically better than those born vaginally but there was little clinical impact. Perhaps in properly selected cases, a planned vaginal breech delivery still has a role to play.

Matched MeSH terms: Breech Presentation

Nifedipine versus terbutaline for tocolysis in external cephalic version

Mohamed Ismail NA, Ibrahim M, Mohd Naim N, Mahdy ZA, Jamil MA, Mohd Razi ZR

Int J Gynaecol Obstet, 2008 Sep;102(3):263-6.

PMID: 18554601 DOI: 10.1016/j.ijgo.2008.04.010

To study the efficacy of nifedipine compared with terbutaline as a tocolytic agent in external cephalic version (ECV).

Matched MeSH terms: Breech Presentation/drug therapy*; Breech Presentation/therapy

Intravenous salbutamol for external cephalic version

Vani S, Lau SY, Lim BK, Omar SZ, Tan PC

Int J Gynaecol Obstet, 2009 Jan;104(1):28-31.

PMID: 18922525 DOI: 10.1016/j.ijgo.2008.08.014

To evaluate the success of external cephalic version (ECV) using an adjusted bolus dose of intravenous salbutamol compared with no tocolysis.

Matched MeSH terms: Breech Presentation/drug therapy; Breech Presentation/therapy*

Fulltext Oral nifepidine versus subcutaneous terbutaline tocolysis for external cephalic version: a double-blind randomised trial

Collaris R, Tan PC

BJOG, 2009 Jan;116(1):74-80; discussion 80-1.

PMID: 19087079 DOI: 10.1111/j.1471-0528.2008.01991.x

To evaluate oral nifedipine versus subcutaneous terbutaline tocolysis for external cephalic version (ECV).

Matched MeSH terms: Breech Presentation/drug therapy*; Breech Presentation/therapy

Is there a place for selective vaginal breech delivery in Malaysian hospitals: experiences from the Ipoh Hospital

Nalliah S, Loh KY, Japaraj RP, Mukudan K

J Matern Fetal Neonatal Med, 2009 Feb;22(2):129-36.

PMID: 19197787 DOI: 10.1080/14767050802509520

The 'Term Breech Trial' (TBT) results of 2001 have impacted on the mode of delivery of breech with a low threshold for caesarean delivery (CD) worldwide.

Matched MeSH terms: Breech Presentation/epidemiology*

Fulltext Early versus late ecv in primigravidae with breech presentation: a pilot study

Nor Azlin, M.I., Norliza, H., Norzilawati, M.N., Mahdy, Z.A., Shuhaila, A., Jamil, M.A.

Malaysian Journal of Public Health Medicine, 2013;13(1):20-27.

MyJurnal

This was a pilot study comparing the success between early versus late external cephalic version (ECV) involving primigravidae with singleton breech pregnancy. They were randomised into early (34–36 weeks) and late (37-40 weeks) ECV groups. A total of 44 women were initially randomised into 22 women for each group. The overall ECV success rate was acceptable in both groups although insignificantly higher in the late ECV group (55.6% versus 46.7%, p= 0.732.) Caesarean
section in the early ECV group was higher (80% versus 72.2%). Early ECV group had women with higher BMI (29.5 versus 26.8 kg/m2, p=0.107), anterior placentation (60% versus 38.9%) and extended breech presentation (55.6% versus 44.4%; p= 0.296). In conclusion, early ECV in primigravidae showed no better success rate than late ECV. Maternal obesity, anterior placentation and extended breech presentation should alert to failure risk.

Matched MeSH terms: Breech Presentation

Fulltext Talcum powder or aqueous gel to aid external cephalic version: a randomised controlled trial

Vallikkannu N, Nadzratulaiman WN, Omar SZ, Si Lay K, Tan PC

BMC Pregnancy Childbirth, 2014 Jan 28;14:49.

PMID: 24468078 DOI: 10.1186/1471-2393-14-49

BACKGROUND: External cephalic version (ECV) is offered to reduce the number of Caesarean delivery indicated by breech presentation which occurs in 3-4% of term pregnancies. ECV is commonly performed aided by the application of aqueous gel or talcum powder to the maternal abdomen. We sought to compare gel with powder during ECV on achieving successful version and increasing tolerability.

METHOD: We enrolled 95 women (≥ 36 weeks gestation) on their attendance for planned ECV. All participants received terbutaline tocolysis. Regional anaesthesia was not used. ECV was performed in the standard fashion after the application of the allocated aid. If the first round (maximum of 2 attempts) of ECV failed, crossover to the opposing aid was permitted.

RESULTS: 48 women were randomised to powder and 47 to gel. Self-reported procedure related median [interquartile range] pain scores (using a 10-point visual numerical rating scale VNRS; low score more pain) were 6 [5-9] vs. 8 [7-9] P = 0.03 in favor of gel. ECV was successful in 21/48 (43.8%) vs. 26/47 (55.3%) RR 0.6 95% CI 0.3-1.4 P = 0.3 for powder and gel arms respectively. Crossover to the opposing aid and a second round of ECV was performed in 13/27 (48.1%) following initial failure with powder and 4/21 (19%) after failure with gel (RR 3.9 95% CI 1.0-15 P = 0.07). ECV success rate was 5/13 (38.5%) vs. 1/4 (25%) P = 0.99 after crossover use of gel or powder respectively. Operators reported higher satisfaction score with the use of gel (high score, greater satisfaction) VNRS scores 6 [4.25-8] vs 8 [7-9] P = 0.01.

CONCLUSION: Women find gel use to be associated with less pain. The ECV success rate is not significantly different.

TRIAL REGISTRATION: The trial is registered with ISRCTN (identifier ISRCTN87231556).

Matched MeSH terms: Breech Presentation/therapy*

Mode of delivery and outcomes in preterm births

Sangkomkamhang U, Pattanittum P, Laopaiboon M, Lumbiganon P

J Med Assoc Thai, 2011 Apr;94(4):415-20.

PMID: 21591525

To compare maternal and neonatal outcomes by mode of delivery in preterm births.

Matched MeSH terms: Breech Presentation/etiology

Tocolysis in term breech external cephalic version

Nor Azlin MI, Haliza H, Mahdy ZA, Anson I, Fahya MN, Jamil MA

Int J Gynaecol Obstet, 2005 Jan;88(1):5-8.

PMID: 15617697

To study the effect of ritodrine tocolysis on the success of external cephalic version (ECV) and to assess the role of ECV in breech presentation at our centre.

Matched MeSH terms: Breech Presentation

Brachial plexus injuries in Malaysian neonates: incidence and associated risk factors

Boo NY, Lye MS, Kanchanamala M, Ching CL

J Trop Pediatr, 1991 12;37(6):327-30.

PMID: 1791654 DOI: 10.1093/tropej/37.6.327

A prospective study was carried out on 26,176 Malaysian neonates born in the Maternity Hospital, Kuala Lumpur over a 12-month period to determine the incidence and associated risk factors of brachial plexus injuries. This condition was found in 42/26,176 neonates (1.6 per 1000 livebirths). Multiple logistic regression analysis of affected and control neonates from a nested case-control study showed that increasing birth weights and breech deliveries were the significant risk factors. Our study suggests that to reduce the occurrence of this condition, there is a need for: (i) better assessment of fetal size and maternal pelvimetry to enable earlier diagnosis of cephalo-pelvic disproportion, and (ii) review of the indications and techniques of breech delivery.

Matched MeSH terms: Breech Presentation

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