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Eileen K. Hutton - One of the best experts on this subject based on the ideXlab platform.

  • Labour Outcomes After Successful External Cephalic Version Compared With Spontaneous Cephalic Version
    Journal of obstetrics and gynaecology Canada, 2017
    Co-Authors: Samantha Krueger, Julia Simioni, Lauren E. Griffith, Eileen K. Hutton
    Abstract:

    Abstract Objective This study sought to compare obstetrical outcomes for women with a Cephalic Presentation at birth resulting from successful external Cephalic version (ECV) compared to those resulting from spontaneous Cephalic version (SCV). Methods Secondary analysis was performed on Early External Cephalic Version Trial data. A total of 931 study participants had breech Presentations between 34 and 36 weeks' gestation and Cephalic Presentations at birth. The incidence of intrapartum interventions was compared between patients with successful ECV (557) and those with SCV (374). A generalized linear mixed model was used to determine ORs for our primary outcomes. Parity, maternal BMI, previous CS, and enrolment centre were controlled for in the analysis. Results No differences were found after ECV compared with SCV in the incidence of CS (96 of 557 and 76 of 374, respectively; adjusted OR [aOR] 0.89; 95% CI 0.63–1.26), instrumental birth (68 of 557 and 29 of 373, respectively; aOR 1.55; 95% CI 0.96–2.50), or normal vaginal birth (393 of 557 and 268 of 373, respectively; aOR 0.92; 95% CI 0.68–1.24). Multiparous women with successful ECV were half as likely to require a CS compared with those with SCV and no ECV (28 of 313 and 42 of 258, respectively; aOR 0.45; 95% CI 0.26–0.80). Conclusion This is the first study to compare birth outcomes of breech pregnancies that convert to Cephalic Presentation by means of SCV with birth outcomes of breech pregnancies that have ECV. Women with a Cephalic-presenting fetus at birth as a result of successful ECV are not at greater risk of obstetrical interventions at birth when compared with women with fetuses who spontaneously turn to a Cephalic Presentation in the third trimester.

  • Predictors of success of external Cephalic version and Cephalic Presentation at birth among 1253 women with non-Cephalic Presentation using logistic regression and classification tree analyses.
    Acta Obstetricia et Gynecologica Scandinavica, 2017
    Co-Authors: Eileen K. Hutton, Julia Simioni, Lehana Thabane
    Abstract:

    Introduction Among women with a fetus with a non-Cephalic Presentation, external Cephalic version (ECV) has been shown to reduce the rate of breech Presentation at birth and cesarean birth. Compared with ECV at term, beginning ECV prior to 37 weeks’ gestation decreases the number of infants in a non-Cephalic Presentation at birth. The purpose of this secondary analysis was to investigate factors associated with a successful ECV procedure and to present this in a clinically useful format. Material and methods Data were collected as part of the Early ECV Pilot and Early ECV2 Trials, which randomized 1776 women with a fetus in breech Presentation to either early ECV (34–36 weeks’ gestation) or delayed ECV (at or after 37 weeks). The outcome of interest was successful ECV, defined as the fetus being in a Cephalic Presentation immediately following the procedure, as well as at the time of birth. The importance of several factors in predicting successful ECV was investigated using two statistical methods: logistic regression and classification and regression tree (CART) analyses. Results Among nulliparas, non-engagement of the presenting part and an easily palpable fetal head were independently associated with success. Among multiparas, non-engagement of the presenting part, gestation less than 37 weeks and an easily palpable fetal head were found to be independent predictors of success. These findings were consistent with results of the CART analyses. Conclusions Regardless of parity, descent of the presenting part was the most discriminating factor in predicting successful ECV and Cephalic Presentation at birth.

  • External Cephalic Version (ECV) and the Early ECV Trial
    Journal SOGC, 1999
    Co-Authors: Eileen K. Hutton, Mary E. Hannah, Kofi Amankwah, Karyn Kaufman, Ellen Hodnett
    Abstract:

    Abstract The Caesarean section rate among women with breech pregnancies at term is approximately 70 percent. External Cephalic version (ECV) has a recognized role in decreasing the likelihood of Caesarean section in women with breech pregnancies. External Cephalic version prior to 37 weeks gestation has been abandoned in favour of initiating ECV at or after 37 weeks, with or without the use of tocolytic medication to facilitate the procedure. In North America and Europe, when the manoeuvre is undertaken at or after 37 weeks gestation, the rate of successful version resulting in a Cephalic Presentation at the time of delivery has remained low, particularly amongst nulliparous women. There is increasing interest in beginning ECV as early as 34 weeks gestation for selected women, as an approach to decreasing the overall rate of non-Cephalic Presentations at term. The Early ECV Trial is a multicentred, randomized controlled trial comparing the selective use of ECV beginning at 34 weeks gestation to ECV after 37 weeks. The primary outcome is the rate of non-Cephalic Presentation at the time of birth. Collaborators in the Early ECV Trial include midwives and obstetricians from Toronto, Scarborough, Mississauga, Calgary, Ottawa, Thunder Bay and Hamilton.

Helen M West - One of the best experts on this subject based on the ideXlab platform.

  • external Cephalic version for breech Presentation at term
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Justus G Hofmeyr, Regina Kulier, Helen M West
    Abstract:

    Background External Cephalic version (ECV) of the breech fetus at term (after 37 weeks) has been shown to be effective in reducing the number of breech Presentations and caesarean sections, but the rates of success are relatively low. This review examines studies initiating ECV prior to term (before 37 weeks' gestation). Objectives To assess the effectiveness of a policy of beginning ECV before term (before 37 weeks' gestation) for breech Presentation on fetal Presentation at birth, method of delivery, and the rate of preterm birth, perinatal morbidity, stillbirth or neonatal mortality. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies. Selection criteria Randomised controlled trials (RCTs) of ECV attempted before term (37 weeks' gestation) or commenced before term, compared with a control group of women (in breech Presentation) in which either no ECV attempted or ECV was attempted at term. Cluster-randomised trials were eligible for inclusion but none were identified. Quasi-RCTs or studies using a cross-over design were not eligible for inclusion. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. Studies were assessed for risk of bias and for important outcomes the overall quality of the evidence was assessed using the GRADE approach. Main results Five studies are included (2187 women). It was not possible for the intervention to be blinded, and it is not clear what impact lack of blinding would have on the outcomes reported. For other 'Risk of bias' domains studies were either at low or unclear risk of bias. One study reported on ECV that was undertaken and completed before 37 weeks' gestation compared with no ECV. No difference was found in the rate of non-Cephalic Presentation at birth (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.64 to 1.69; participants = 102). One study reported on a policy of ECV that was initiated before term (33 weeks) and up until 40 weeks' gestation and which could be repeated up until delivery compared with no ECV. This study showed a decrease in the rate of non-Cephalic Presentation at birth (RR 0.59, 95% CI 0.45 to 0.77; participants = 179). Three studies reported on ECV started at between 34 to 35 weeks' gestation compared with beginning at 37 to 38 weeks' gestation. Pooled results suggested that early ECV reduced the risk of non-Cephalic Presentation at birth (RR 0.81, 95% CI 0.74 to 0.90; participants = 1906; studies = three; I² = 0%, evidence graded high quality), failure to achieve vaginal Cephalic birth (RR 0.90, 95% CI 0.83 to 0.97; participants = 1888; studies = three; I² = 0%, evidence graded high quality), and vaginal breech delivery (RR 0.44, 95% CI 0.25 to 0.78; participants = 1888; studies = three; I² = 0%, evidence graded high quality). The difference between groups for risk of caesarean was not statistically significant (RR 0.92, 95% CI 0.85 to 1.00; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was evidence that risk of preterm labour was increased with early ECV compared with ECV after 37 weeks (6.6% in the ECV group and 4.3% for controls) (RR 1.51, 95% CI 1.03 to 2.21; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was no clear difference between groups for low infant Apgar score at five minutes or perinatal death (stillbirth plus neonatal mortality up to seven days) (evidence graded as low quality for both outcomes). Authors' conclusions Compared with no ECV attempt, ECV commenced before term reduces non-Cephalic Presentation at birth. Compared with ECV at term, beginning ECV at between 34 to 35 weeks may have some benefit in terms of decreasing the rate of non-Cephalic Presentation, and risk of vaginal breech birth. However, early ECV may increase risk of late preterm birth, and it is important that any future research reports infant morbidity outcomes. Results of the review suggest that there is a need for careful discussion with women about the timing of the ECV procedure so that they can make informed decisions.

Sharon Maslovitz - One of the best experts on this subject based on the ideXlab platform.

  • Efficacy of a second external Cephalic version (ECV) after a successful first external Cephalic version with subsequent spontaneous reinversion to breech Presentation: a retrospective cohort study
    Archives of Gynecology and Obstetrics, 2020
    Co-Authors: Lee Reicher, Anat Lavie, Yuval Fouks, Ofer Isakov, Emmanuel Attali, Yariv Yogev, Sharon Maslovitz
    Abstract:

    Objective Determining the efficacy of performance of a second external Cephalic version (ECV) following successful first ECV with subsequent spontaneous reinversion to breech Presentation in reducing the rate of cesarean delivery (CD). Methods Data were reviewed on healthy women with fetuses in breech Presentation who underwent a first ECV after 36 weeks. Routine ultrasound study was performed at 39-week gestation, and a repeat ECV procedure was performed if the fetus had reverted to non-Cephalic Presentation. Obstetrical outcome measures were compared between women who underwent one successful ECV between 36- and 41-week gestation in which the fetus remained in Cephalic Presentation until labor and those who underwent a successful first ECV after which the fetus returned to breech and a second ECV was performed. The primary outcome was the rate of secondary CD during vaginal delivery in Cephalic Presentation; rate of successful second ECV was the secondary outcome. Results Overall 250 women underwent one ECV attempt of which 169 (67%) were successful. Of them 28 reverted to breech Presentation, all women underwent two attempts of which 21 (76%) were successful. A second successful ECV attempt was associated with a 33% incidence of a CD vs. 2.8% after one successful ECV in which the fetus remained in Cephalic Presentation. Conclusion A second ECV after a successful first ECV with subsequent spontaneous reversion to breech Presentation can be expected to be successful in 76% of cases but lead to CD in 33% of cases. Our findings can be used to support patient counseling and decision-making before second ECV attempt.

  • Success rates of early versus late initiation of external Cephalic version.
    International Journal of Gynecology & Obstetrics, 2019
    Co-Authors: Anat Lavie, Lee Reicher, Sarit Avraham, Maya Ram, Sharon Maslovitz
    Abstract:

    OBJECTIVE To determine optimum timing of external Cephalic version (ECV). METHODS A retrospective cohort study was conducted at a tertiary hospital in Israel between February 1, 2016, and July 1, 2017. Healthy primiparous women with breech Presentation were offered either early ECV (35-36 weeks; n=54) or late ECV (37-38 weeks; n=106). Group assignment was according to the patient's preference and physician availability. The primary outcome was the rate of Cephalic Presentation at delivery. Secondary outcomes included rate of cesarean delivery, Presentation of fetus after the first and last ECVs, and serious fetal complications. RESULTS The incidence of undergoing more than two ECV attempts was 18.5% in the early ECV group and 5.6% in the late ECV group (P=0.039). The incidence of Cephalic Presentation after the first ECV was 72.2% in the early ECV group versus 66.0% in the late ECV group (P=0.048). By contrast, no statistically significant between-group differences were found for Presentation at delivery or rate of cesarean delivery. The other outcomes were also similar. CONCLUSION Early initiation of ECV among primiparous women increased the chance of immediate Cephalic Presentation; however, it had no effect on Presentation at delivery or cesarean delivery rate.

Nicolaides K. H. - One of the best experts on this subject based on the ideXlab platform.

  • Value of routine ultrasound examination at 35-37 weeks' gestation in diagnosis of non-Cephalic Presentation
    'Wiley', 2020
    Co-Authors: De Castro H., Ciobanu A., Formuso C., Akolekar R., Nicolaides K. H.
    Abstract:

    Background: Undiagnosed non-Cephalic Presentation in labor carries increased risks for both the mother and baby. Routine pregnancy care based on maternal abdominal palpation fails to detect the majority of non-Cephalic Presentations. Objective: To report the incidence of non-Cephalic Presentation at a routine scan at 35+0 - 36+6 weeks’ gestation and subsequent management of such pregnancies. Methods: This was a retrospective analysis of prospectively collected data in 45,847 singleton pregnancies that had undergone routine ultrasound examination at 35+0 - 36+6 weeks’ gestation. Patients with breech or transverse / oblique Presentation were divided into two groups, first those that would have elective cesarean section for fetal or maternal indications other than the abnormal Presentation, and second, those that would potentially require ECV. The latter group was reassessed in 1-2 weeks and if there was persistence of the abnormal Presentation the parents were offered the options of ECV versus elective cesarean section at 38-40 weeks’ gestation. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal and pregnancy characteristics provided a significant contribution in the prediction of first, non-Cephalic Presentation at the 35+0 - 36+6 weeks scan, second, successful ECV from non-Cephalic to Cephalic Presentation, and third, spontaneous rotation from non-Cephalic to Cephalic Presentation. Results: First, at 35+0 - 36+6 weeks the fetal Presentation was Cephalic in 43,416 (94.7%) pregnancies, breech in 1,987 (4.3%) and transverse or oblique in 444 (1.0%). Second, multivariable analysis demonstrated that the chance of non-Cephalic Presentation increased with increasing maternal age and weight, decreasing height, earlier gestational age at scan, and it was higher in the presence of placenta previa, oligohydramnios and polyhydramnios, in nulliparous than parous women and lower in women of South Asian and mixed racial origin than in White women. Third, 22% of cases of non-Cephalic Presentation were not eligible for ECV because of planned cesarean section for indications other than the malPresentation. Fourth, of those eligible for ECV only 48.5% (646/1,332) accepted the procedure and this was successful in 39.0% (252/646) of cases. Fifth, the chance of successful ECV increased with increasing maternal age and was lower in nulliparous than parous women. Sixth, in 33.9% (738/2,179) of pregnancies with non-Cephalic Presentation where successful ECV was not carried out there was a subsequent spontaneous rotation to Cephalic Presentation. Seventh, the chance of spontaneous rotation from non-Cephalic to Cephalic Presentation increased with increasing interval between the scan and delivery and decreased with increasing birth weight, it was higher in women of Black than White racial origin, if the Presentation was transverse or oblique than breech and if there was polyhydramnios and lower in nulliparous than parous women and in the presence of placenta previa. Eighth, in 109 (0.3%) of Cephalic Presentations there was subsequent rotation to non-Cephalic Presentation and in 41% of these the diagnosis was made during labor. Ninth, in the total of 2,431 cases of non-Cephalic Presentation at the time of the scan the Presentation at birth was Cephalic in 985 (40.5%); in 738 (74.9%) this was due to spontaneous rotation and in 247 (25.1%) due to successful ECV. Tenth, prediction of non-Cephalic Presentation at the 35+0 - 36+6 weeks scan and successful ECV from maternal and pregnancy factors was poor, but prediction of spontaneous rotation from non-Cephalic to Cephalic Presentation was moderately good and this could be incorporated in the counselling of women prior to undertaking ECV. Conclusions: The problem of unexpected non-Cephalic Presentation in labor can to a great extent be overcome by a routine ultrasound examination at 35+0 - 36+6 weeks’ gestation. The incidence of non-Cephalic Presentation at the 35+0 - 36+6 weeks scan was about 5%, but, in about 40% of these cases the Presentation at birth was Cephalic, mainly due to subsequent spontaneous rotation and to a lesser extent as a consequence of successful ECV

Marie Victoire Sénat - One of the best experts on this subject based on the ideXlab platform.

  • Internal Version Compared With Pushing for Delivery of Cephalic Second Twins
    Obstetrics and Gynecology, 2020
    Co-Authors: Victoire Pauphilet, Elie Azria, Françcois O. Goffinet, Aurélien Seco, Anne Gaël Cordier, Philippe Deruelle, Gilles Kayem, Patrick Rozenberg, Nicolas Sananès, Marie Victoire Sénat
    Abstract:

    OBJECTIVE: To assess neonatal morbidity and mortality according to whether Cephalic second twins were born after internal version followed by total breech extraction or after instructions to push. We hypothesized that interval version would result in shorter intertwin delivery intervals and lower cesarean delivery rates for the second twin and therefore better neonatal outcomes. METHODS: These planned analyses of the JUMODA (JUmeaux MODe d'Accouchement) cohort, a national prospective population-based study of twin deliveries, examined births of Cephalic second twins after vaginal birth of the first twin at or after 32 weeks of gestation. The internal version group of second twins born in breech Presentation after obstetric maneuvers was compared with the pushing group, comprising those born in Cephalic Presentation. The primary outcome was a composite of neonatal morbidity and mortality. Multivariate modified Poisson regression models were used to control for potential confounders. RESULTS: Of 2,256 Cephalic second twins, 487 (21.6%) were born in breech Presentation after internal version and total breech extraction and 1,769 (78.4%) in Cephalic Presentation after pushing. Composite neonatal morbidity and mortality was not lower in the internal version (17/487 [3.5%]) compared with the pushing group (38/1,769 [2.1%]; adjusted relative risk [aRR] 1.73 [95% CI 0.98-3.05]), although median [quartile 1-quartile 3] intertwin delivery intervals were shorter (5 [4-8] vs 8 [5-12] minutes, P