Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term

Meghana Limaye; Najma Abdullahi; Phinnara Has; Valery A. Danilack; Rosemary Froehlich; Erika Werner

doi:10.1055/s-0039-1695748

American Journal of Perinatology Reports, Table of Contents

CC BY-NC-ND 4.0 · AJP Rep 2019; 09(04): e323-e327
DOI: 10.1055/s-0039-1695748

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term

Meghana Limaye

¹Department of Obstetrics & Gynecology, NYU Langone Medical Center, New York, New York

,

Najma Abdullahi

²Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island

,

Phinnara Has

²Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island

,

Valery A. Danilack

²Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island

,

Rosemary Froehlich

³Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

,

Erika Werner

²Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island

› Author Affiliations

Abstract

Objective To assess differences in patient characteristics between women who did and did not undergo attempted external cephalic version (ECV) for fetal malpresentation at term.

Study Design This was a retrospective cohort study of women with a singleton gestation and noncephalic presentation at > 37.0 weeks between October 2014 and October 2015. We compared demographic and clinical characteristics of women who did and did not undergo attempted ECV and assessed the reasons that women did not attempt ECV.

Results Among 215 women, only 51 (24%) attempted ECV. There were no differences in age, race, insurance type, or body mass index between women who underwent attempted ECV and those who did not. Women who underwent ECV were significantly more likely to have had a prior vaginal delivery (69 vs. 36%, p < 0.001). Seventy-six women (46%) declined ECV. Women who declined ECV were more likely to be nulliparous than those who accepted the procedure (66 vs. 29%, p < 0.001). Among women who had ECV, the success rate was 55%. There were no adverse events after attempted ECV in this cohort.

Conclusion Among women with fetal malpresentation at term, those without a prior vaginal delivery were significantly less likely to undergo attempted ECV.

Keywords

external cephalic version - fetal malpresentation - prevention of primary cesarean delivery - utilization of external cephalic version

Full Text

References

References
1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep 2018; 67 (01) 1-55
2 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
3 Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2014. Natl Vital Stat Rep 2015; 64 (12) 1-64
4 ACOG. ACOG Practice Bulletin 161: External Cephalic Version. Obstet Gynecol 2016; 127: 54-61
5 Son M, Roy A, Grobman WA, Miller ES. Association between attempted external cephalic version and perinatal morbidity and mortality. Obstet Gynecol 2018; 132 (02) 365-370
6 Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2015; (04) CD000083
7 Goetzinger KR, Harper LM, Tuuli MG, Macones GA, Colditz GA. Effect of regional anesthesia on the success rate of external cephalic version: a systematic review and meta-analysis. Obstet Gynecol 2011; 118 (05) 1137-1144
8 Fernandez CO, Bloom SL, Smulian JC, Ananth CV, Wendel Jr GD. A randomized placebo-controlled evaluation of terbutaline for external cephalic version. Obstet Gynecol 1997; 90 (05) 775-779
9 Tan JM, Macario A, Carvalho B, Druzin ML, El-Sayed YY. Cost-effectiveness of external cephalic version for term breech presentation. BMC Pregnancy Childbirth 2010; 10: 3
10 Melo P, Georgiou EX, Hedditch A, Ellaway P, Impey L. External cephalic version at term: a cohort study of 18 years' experience. BJOG 2019; 126 (04) 493-499
11 Vlemmix F, Rosman AN, te Hoven S. , et al. Implementation of external cephalic version in the Netherlands: a retrospective cohort study. Birth 2014; 41 (04) 323-329
12 Morgan ER, Hu AE, Brezak AMV, Rowley SS, Littman AJ, Hawes SE. Predictors of a successful external cephalic version: a population-based study of Washington state births. Women Birth 2019; 32 (03) e421-e426
13 Caukwell S, Joels LA, Kyle PM, Mills MS. Women's attitudes towards management of breech presentation at term. J Obstet Gynaecol 2002; 22 (05) 486-488
14 Rosman AN, Vlemmix F, Fleuren MAH. , et al. Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands. Midwifery 2014; 30 (03) 324-330
15 Say R, Thomson R, Robson S, Exley C. A qualitative interview study exploring pregnant women's and health professionals' attitudes to external cephalic version. BMC Pregnancy Childbirth 2013; 13: 4