Influence of the external cephalic version attempt on the Cesarean section rate: experience of a type 3 maternity hospit
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MATERNAL-FETAL MEDICINE
Influence of the external cephalic version attempt on the Cesarean section rate: experience of a type 3 maternity hospital in France Benjamin Birene1 · U. Ishaque1 · J. Chrusciel2 · S. Bonneau1 · R. Gabriel1 · O. Graesslin1 Received: 14 March 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To define the effects of attempted external cephalic version (ECV) in a low-risk population for breech delivery in a maternity hospital where breech vaginal delivery is widely practiced. Materials and methods Retrospective exposed—unexposed study including 204 patients presented with a live singleton fetus breech presentation on third-trimester ultrasound and who delivered at Reims University Hospital between January 1st, 2013 and July 1st, 2018. Results 121 patients received ECV. Cesarean section rate was lower (OR with no adjustment 0.42 [0.24–0.76] p = 0.004) but without significant difference in the exposed patients after adjustment. This difference was significant between exposed and unexposed patients in the subgroup of 51 primiparous (OR = 0.14 [0.04–0.52] p = 0.002) and 51 multiparous (OR = 0.26 [0.08–0.89] p = 0.028) but not in the subgroup of 102 nulliparous. There was no difference in fetal impact other than neonatal management in the delivery room, which is less needed in exposed primiparous women. Attempted ECV significantly decreased the breech rate (72.5 vs 100%, p 30 or a polymyomatous uterus because of a very low predictable success rate. Patients with a fetus in the transverse presentation were not excluded from the study but were reported separately. The position of the fetus at delivery was not a group assignment criterion for the included patients. During the patient records review, if any items were missing, clinical and ultrasound data from two days before or after the ECV were considered. For placental position, third-trimester ultrasound was used (Fig. 1).
Women with a Contra-indication
Attempted ECV
Successful ECV
Unattempted
Failed ECV
Fig. 1 Flow Chart
and limited to a maximum of three attempts. Two operators were generally present: a senior physician and an intern who could initiate the procedure. After the ECV, whatever the result, a new evaluation of the CTG was performed for 60 min followed by a Kleihauer test. Rhesus-negative patients were previously given an injection of anti-D immunoglobulin. A follow-up consultation to retrieve the result of the Kleihauer test and to perform a new control of the CTG was systematic at 24–48 h after the procedure. In case of failure or if no ECV was performed, and if a vaginal delivery was not contraindicated, a pelvimetry was performed. The decision on mode of delivery was taken by the obstetrician who had supervised the patient or by the one on duty if the pregnancy had been monitored by a midwife, and if the confrontation between fetal biometrics and pelvimetry was satisfactory. If a vaginal delivery was allowed, an ultrasound estimate of the biparietal diamet
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