Abstract
Introduction Fetal breech presentation at terms occurs in 3 – 6% of pregnancies. External cephalic
version can reduce the number of cesarean sections and vaginal breech deliveries.
Different approaches are used to carry out external cephalic version. This study looked
at the different approaches used in Germany and compared the approach used with the
recommendations given in German and international guidelines.
Material and Methods An anonymized online survey of 234 hospitals in Germany was carried out in 2018.
In addition to asking about hospital structures, questions also focused on how external
version was carried out in practice (preparations, tocolysis, anesthetics, etc.),
on relative and absolute contraindications and on the success rate.
Results 37.2% of the hospitals approached for the survey participated in the study. Of these,
98.8% performed external version procedures. The majority of participating hospitals
were university hospitals (26.4%) and maximum care hospitals (35.6%) with an average
number of more than 2000 births per year (60.9%). External cephalic version is the
preferred (61.7%) obstetrical procedure to deal with breech presentation, rather than
vaginal breech birth or primary cesarean section. 45.8% of respondents carry out external
version procedures on an outpatient basis, and 42.1% of hospitals perform the procedure
as an inpatient intervention, especially from the 37th week of gestation. Prior to
performing an external version procedure, 21.6% of surveyed institutions carry out
a vaginal examination to evaluate possible fixation of the fetal rump. 95.5% of institutions
used fenoterol for tocolytic therapy; the majority using it for continuous tocolysis
(70.2%). 1 – 3 attempts
at external version (8.4%) were usually carried out by a specific senior physician.
In most cases, no analgesics were administered. The reported rate of emergency cesarean
sections was very low. The most common indication for emergency C-section was pathological
CTG (56,7%). The assessment of relative and absolute contraindications varied, depending
on the surveyed hospital. 67.5% asked patients to empty their bladders before carrying
out external version, while 10.8% carried out external version when the bladder was
filled. The reported success rate was more than 45%. After successful version, only
14.8% of hospitals arranged for patients to wear an abdominal binder. For 32.4%, the
decision to apply an abdominal binder was taken on a case-by-case basis.
Conclusion The approach used in Germany to carry out external cephalic version is based on the
(expired) German guideline on breech presentation. Based on the evidence obtained,
a number of individual recommendations should be re-evaluated. More recent international
guidelines could be useful to update the standard procedure.
Key words
external version - breech presentation - cesarean section
