Frequency of External Cephalic Version in Women with Breech Presentation at Term

Main Article Content

Aleena Ali
Annum Rashid
Saadia Naeem
Memoona Mehboob

Abstract

Background: External cephalic version (ECV) is a pivotal obstetric procedure aimed at reducing caesarean section rates by correcting fetal breech presentation to cephalic presentation through maternal abdominal manipulation. Despite its established efficacy, variability in success rates across different populations and healthcare settings highlights the need for continued evaluation of its clinical application and outcomes.


Objective: To assess the success rate of ECV in term pregnancies with breech presentation and identify factors influencing its outcomes in a tertiary care setting.


Methods: This cross-sectional study was conducted at the Gynecology & Obstetrics Unit of Lady Reading Hospital, Peshawar, between November 21, 2019, and May 21, 2020. A sample size of 100 women with singleton pregnancies, aged 20-35 years, presenting with breech at term (37-42 weeks), was included using non-probability consecutive sampling. Exclusion criteria encompassed contraindications to vaginal delivery or ECV. Data on demographic characteristics, obstetric history, and ECV outcomes were collected. The procedure was performed by experienced obstetricians under ultrasound guidance. Statistical analysis was conducted using SPSS version 25.0, with chi-square tests applied to assess associations between variables and ECV success.


Results: The mean age of participants was 30 years (SD ± 5.887), with a mean gestational age of 38 weeks (SD ± 3.94). The success rate of ECV was 57%. Multigravida women constituted 73% of the sample. No significant associations were found between ECV success and age groups (P=0.8792), gestational period (P=0.9699), gravidity (P=0.7813), obesity (P=0.7519), or educational level (P=0.9668).


Conclusion: The study confirms a 57% success rate for ECV in correcting breech presentations at term, reinforcing the procedure's role in potentially reducing the need for caesarean sections. These findings support the incorporation of ECV into obstetric practice as a standard of care for eligible women with breech presentations, highlighting the necessity for skilled providers and patient education to optimize outcomes.

Article Details

How to Cite
Ali, A., Rashid, A., Naeem, S., & Mehboob, M. (2024). Frequency of External Cephalic Version in Women with Breech Presentation at Term. Journal of Health and Rehabilitation Research, 4(1), 1685–1690. https://doi.org/10.61919/jhrr.v4i1.682
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Articles
Author Biographies

Aleena Ali, Civil Dispensary Hussainabad Health Department KP Pakistan.

Women Medical Officer Incharge Civil Dispensary Hussainabad, Health Department KP Pakistan.

Annum Rashid, Government Maternity Hospital Peshawar Pakistan.

Women Medical Officer, Government Maternity Hospital Peshawar, Health Department KP Pakistan.

Saadia Naeem, Type D Hospital Lachi Pakistan.

Women Medical Officer, Type D Hospital Lachi Pakistan.

Memoona Mehboob, Rural Health Centre Ghoriwala Bannu Pakistan.

Women Medical Officer, Health Department Bannu, RHC Ghoriwala Bannu Pakistan.

References

Royal College of Obstetricians and Gynaecologists. External Cephalic Version and Reducing the Incidence of Term Breech Presentation; Green-top Guideline No. 20a. 2017.

Andrews S, Leeman L, Yonke N. Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version. Birth. 2017 Sep;44(3):222-9.

Hussin O, Mahmoud M, Abdel Fattah M. External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section. Eastern Mediterranean Health Journal. 2013 Feb;19(02):162-6.

Ebner F, Friedl T, Leinert E, Schramm A, Reister F, Lato K, et al. Predictors for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet. 2016 Apr;293(4):749-55.

Al-Jwadi SA, Al-Ibrahim BL. External cephalic version for breech presentation at term. A prospective interventional study. Saudi Med J. 2014 Aug;35(8):843-8.

Wright RC. Reduction of perinatal mortality and morbidity in breech delivery through routine use of cesarean section. Obstet Gynecol. 1959;14:758-63.

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. Obstet Gynecol Int. 2017 Apr;2017:1-6.

Cammu H, Donny N, Martens G, Colman R. Common determinants of breech presentation at birth in singletons: a population-based study. Eur J Obstet Gynecol Reprod Biol. 2014;177:106-9.

de Hundt M, Velzel J, de Groot CJ, Mol BW, Kok M. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014 Jun;123(6):1327-34.

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.

Cheng M, Hannah M. Breech delivery at term: a critical review of the literature. Obstet Gynecol. 1993 Oct;82(4 Pt 1):605-18.

Kareem R, Jabeen S. Comparison of mode of delivery in undiagnosed breech presentation in labour. J Postgrad Med Inst. 2013;27(2):170-3.

Modi DA, Rami BD, Gadhavi K. Fetomaternal outcome in primi breech at term pregnancy. Int J Res Med. 2016;5(1):75-8.

Wasim T, Wasim AZ, Majrooh MA. Singleton Vaginal Breech Delivery at Term: Maternal and Perinatal Outcome. Ann King Edward Med Univ. 2017;23:7-12.

Ballas S, Toaff R. Hyperextension of the fetal head in breech presentation: radiological evaluation and significance. Br J Obstet Gynaecol. 1976 Mar;83(3):201-4.

Zhang J, Bowes WA Jr, Fortney JA. Efficacy of external cephalic version: a review. Obstet Gynecol. 1993 Aug;82(2):306-12.

Green JE, McLean F, Smith LP, Usher R. Has an increased cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma, and death? Am J Obstet Gynecol. 1982 Mar 15;142(6 Pt 1):643-8.

Eller DP, VanDorsten JP. Route of delivery for the breech presentation: a conundrum. Am J Obstet Gynecol. 1995 Aug;173(2):393-6; discussion 396-8.

Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2015 Apr 1;(4):CD000083.

de Hundt M, Vlemmix F, Bais JM, de Groot CJ, Mol BW, Kok M. Risk factors for cesarean section and instrumental vaginal delivery after successful external cephalic version. J Matern Fetal Neonatal Med. 2016 Jun;29(12):2005-7.

Cook HA. Experience with external cephalic version and selective vaginal breech delivery in private practice. Am J Obstet Gynecol. 1993 Jun;168(6 Pt 1):1886-9.

Gifford DS, Keeler E, Kahn KL. Reductions in cost and cesarean rate by routine use of external cephalic version: a decision analysis. Obstet Gynecol. 1995 Jun;85(6):930-6.

Bowes WA Jr. External Cephalic Version. Obstet Gynecol. 2016 Feb;127(2):412-3.

Hutton E, Hannah M, Ross S, Delisle MF, Carson G, Windrim R, et al. The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies. BJOG. 2011 Apr;118(5):564-77.

Hutton EK, Hofmeyr GJ, Dowswell T. External cephalic version for breech presentation before term. Cochrane Database Syst Rev. 2015 Jul 29;(7):CD000084.

Marquette GP, Boucher M, Theriault D, Rinfret D. Does the use of a tocolytic agent affect the success rate of external cephalic version? Am J Obstet Gynecol. 1996 Oct;175(4 Pt 1):859-61.

Lau TK, Lo KW, Rogers MS. Pregnancy outcome after successful external cephalic version for breech presentation at term. Am J Obstet Gynecol. 1997 Jan;176(1 Pt 1):218-23.