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Introduction Material and Methods Results Conclusions One of the key challenges regarding the management of twins involves choosing the optimal mode of delivery, which is strongly influenced by the final presentation of both fetuses. In cases of vertex–nonvertex pregnancies attempting the trial of vaginal delivery, external cephalic version (ECV) is one of possible management options. The main objective of this review was to collect and summarize available data in terms of the application of ECV in the population of nonvertex second twins.Using the PRISMA guidelines, we searched for original, English‐language studies investigating ECV in nonvertex second twins. The PubMed/MEDLINE, SCOPUS, and COCHRANE databases were searched until May 2024. Reviews, case reports, editorials, and conference papers were excluded from further analysis. Out of 260 papers retrieved, 10 were subjected to the final analysis in terms of success rates, modes of delivery, and adverse outcomes.The total number of ECVs was 289, with an overall success rate of 64.4%. In the group of successful versions, vertex vaginal delivery was achieved in 171 cases (91.9%). The incidence of adverse maternal and neonatal outcomes was low.The purpose of this review was to consolidate and update the current knowledge regarding ECV in nonvertex second twins. Based on the results of this series of studies, ECV appears to be a reasonable management option. However, it is important to highlight several significant limitations. The primary concern is the lack of recent research in this field over the past three decades, with the most recent study in our review being published in 1998. Furthermore, the actual number of studies addressing this topic is relatively low, characterized by a retrospective nature and questionable methodologies. These limitations make it challenging to draw definitive conclusions for clinical practice. This is an important message for our community, emphasizing the need for further studies in this area, particularly randomized controlled trials, to evaluate the safety and success rate of vaginal twin delivery after ECV when the second twin presents in a nonvertex position. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions First, to report the incidence of non‐cephalic presentation at a routine 36‐week ultrasound scan, the uptake and success of external cephalic version (ECV) and the incidence of spontaneous rotation from non‐cephalic to cephalic presentation. Second, to determine the maternal and pregnancy characteristics that provide a significant contribution to the prediction of non‐cephalic presentation at the 36‐week scan, successful ECV from non‐cephalic to cephalic presentation and spontaneous rotation from non‐cephalic to cephalic presentation.This was a retrospective analysis of prospectively collected data from 107 875 women with a singleton pregnancy who had undergone a routine ultrasound scan at 35 + 0 to 36 + 6 weeks' gestation. Patients with breech or transverse/oblique presentation were divided into two groups: those scheduled for elective Cesarean section for a fetal or maternal indication other than abnormal presentation, and those that would potentially require ECV. The latter group was reassessed after 1–2 weeks and, if the abnormal presentation persisted, the parents were offered ECV or elective Cesarean section at 38–40 weeks' gestation. Multivariable logistic regression analysis was carried out to determine which maternal and pregnancy characteristics provided a significant contribution in the prediction of non‐cephalic presentation at the 36‐week scan, successful ECV from non‐cephalic to cephalic presentation and spontaneous rotation from non‐cephalic to cephalic presentation.At the 36‐week scan, fetal presentation was cephalic in 101 664 (94.2%) pregnancies and either breech, transverse or oblique in 6211 (5.8%). In 0.3% of cases with cephalic presentation at the 36‐week scan, there was subsequent spontaneous rotation to non‐cephalic presentation, and in half of these, the diagnosis was made during labor or at birth. ECV was attempted in 1584/6211 (25.5%) pregnancies with non‐cephalic presentation at the 36‐week scan and was successful in only 44.1% of cases. In the remaining 74.5% of cases, ECV was not attempted because of any of the following reasons: ECV was declined; Cesarean section was planned for a reason other than abnormal presentation; ECV was planned for the subsequent 1–2 weeks but, in the meantime, there was spontaneous rotation to cephalic presentation; or there was spontaneous onset of labor or rupture of membranes before planned ECV. In 5513/6211 (88.8%) pregnancies with non‐cephalic presentation at the 36‐week scan, ECV was not attempted or was unsuccessful, and in 37.7% of these, there was subsequent spontaneous rotation to cephalic presentation. Among the 6211 pregnancies with non‐cephalic presentation at the 36‐week scan, the presentation at birth was cephalic in 43.8%; in 74.8%, this was due to spontaneous rotation, and in 25.2%, it was due to successful ECV. Multivariable analysis demonstrated that the likelihood of non‐cephalic presentation at the 36‐week scan, that of successful ECV and that of spontaneous rotation from non‐cephalic to cephalic presentation was affected by several maternal and pregnancy characteristics, but the predictive performance for these events was poor, with the area under the receiver‐operating‐characteristics curve ranging from 0.608 to 0.717 and the detection rate at a 10% false‐positive rate ranging from 19.0% to 33.7%.Routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation could improve pregnancy outcome by substantially reducing the risk of unexpected abnormal presentation in labor. However, an additional ultrasound scan for fetal presentation should be considered in all women when they present in labor. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to assess whether a regional simulation‐based training course in external cephalic version (ECV) would lead to the adoption of this technique in hospitals where it was not previously practiced, and to improve success rates in those already performing it. Methods: This was an intervention study where two specialists in obstetrics and gynecology from 10 Portuguese public maternity hospitals attended a structured simulation‐based training in ECV. Hospitals were categorized based on whether ECV was conducted prior to the training program, and on their annual number of deliveries. Main outcomes were the number of ECVs performed in the 2 years before and after the course, and their success rates. Results: Implementation of ECV was achieved in four additional hospitals during the 2 years following the course. Among the three hospitals already performing ECV and able to report their data, no significant differences in success rates were observed in the 2 years following the course (45.6% vs. 47.9%, P = 0.797). After a successful ECV, 77.7% of women had a vaginal delivery. Conclusion: A regional simulation‐based training course in ECV led to an increase in the number of hospitals implementing the technique in the subsequent 2 years, but it did not impact the success rates in centers where it was already performed. This study highlights the potential of simulation‐based courses in ECV, as well as the need to improve patients' access to the technique and to centralize ECV services at a regional level. Synopsis: Simulation‐based training in external cephalic version increased the implementation of the technique but not the success rates in centers where it was already performed. [ABSTRACT FROM AUTHOR]

Objective: To analyze the success rate of external cephalic version (ECV) in pregnant women with a history of previous cesarean section, as well as to describe the rate of complications associated with the procedure. Methods: A retrospective cohort study of women who were offered an ECV at "Virgen de la Arrixaca" Clinic University Hospital (Murcia, Spain) between January 2014 and December 2023. We collected data for previous cesarean delivery, obstetric history, fetal presentation, amniotic fluid volume, ECV success rate, complications related to ECV, mode of delivery, and neonatal outcomes. The study confidently performed ECV under sedation with propofol and tocolysis with ritodrine. Univariate and multivariate analyses were conducted to compare the success rate of ECV, ECV complications, and mode of delivery between women with and without previous cesarean sections. Results: Of 1116 pregnant women who were offered ECV, 911 were included in the study, with 42 having a previous cesarean section. The success rate of ECV in pregnant women with a previous cesarean section was 78.6% (adjusted odds ratio 1.18; 95% confidence interval 0.49–2.86; P = 0.708), with a low complication rate of 9.5%, such as non‐reassuring fetal heart rate (7.1%) or major vaginal bleeding (2.4%). Of the women who attempted a vaginal delivery after ECV, 80.8% were successful. Conclusions: These findings support that ECV is a safe and effective option for women with a previous cesarean section, with success rates comparable to those in women without a previous cesarean section. Synopsis: Success and complication rates of external cephalic version are similar in women with and women without a history of cesarean section. [ABSTRACT FROM AUTHOR]

• ECV decreases the need for cesarean delivery. • One of the barriers to the introduction of ECV is the lack of self-efficacy. • Simulation-based training is a safe approach for the acquisition of technical skills. • There is scarce research on its effectiveness in the implementation and success rate of ECV. • In settings where there is a dedicated team, training courses may not improve the success rate of ECV. To compare the success and complication rates of external cephalic version before and after the implementation of a simulator-based training program at a tertiary care university centre with a dedicated external cephalic version team. In this single-center intervention study , the success rate and the complication rates of external cephalic version in the two years before the implementation of a simulation-based training program for all specialists and residents, were compared with the two years following the event. T- student, Mann-Whitney, and Chi-square tests were used. All data were extracted from the hospital's electronic patient records. A total of 96 external cephalic versions were performed in the 2 years before the training program, and 74 after the training program. The overall success rates were similar between the two groups: 44.8 % before training and 43.2 % after training (p = 0.824). No major complications occurred, and no emergency cesarean deliveries were performed in either period. In a tertiary care university training center with a dedicated team in external cephalic version, a structured simulation-based training program did not impact the success rate or the complication rates of the procedure. [ABSTRACT FROM AUTHOR]

Objectives: External cephalic version (ECV) is an alternative to caesarean section for abnormal fetal position. ECV is recommended by the most important scientific committees in the world. ECV complications are rare and occur in 6.1% of cases, however severe complications requiring urgent caesarean section are found in less than 0.4%. Our aim was to demonstrate the effectiveness and safety of ECV and to present our own experience with the procedure of ECV. Material and methods: ECV was performed on 62 patients (32 nulliparas and 30 multiparas). Qualification criteria included: singleton gestation, gestational age > 36 + 6, longitudinal pelvic lie, no uterine contractions, intact membranes. Indications for immediate cesarean section within 24 hours of ECV were considered a procedural complication. In patients with complications, the condition of the newborn was checked according to the APGAR score and the day of discharge of the mother and child from the maternity ward was analyzed. Results: ECV finished successfully in 66.1% (nulliparas 56.2% and multiparas 76.7%). Patients with a successful ECV were significantly older and had higher median gestational age. ECV was more often successful when placenta was located on the posteriori wall. In our patients, there were 4 cases of complications requiring delivery at the time of ECV. No serious consequences associated with increased maternal or neonatal morbidity or mortality were reported. Conclusions: ECV seems to be a safe alternative for women wishing to deliver vaginally, as this procedure does not increase the risk of adverse obstetric outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background External cephalic version (ECV) is a medical procedure in which an extracorporeal manipulation is performed to render the breech presentation (BP) fetus in the cephalic position. The use of anesthesia to facilitate repositioning has been evaluated in various randomized clinical trials (RCTs), but its potential effectiveness remains controversial. Methods A systematic literature search was carried out in 8 electronic databases. In the meta-analysis, a random effects model was used to calculate the pooled relative risk (RR) and its 95% confidence interval (CI), and the pooled standardized mean difference (SMD) and its 95% CI, in order to systematically assess the effect of anesthesia on the success rates of ECV, vaginal delivery, cesarean delivery as well as other outcomes. Relevant subgroup analyses, publication bias test and sensitivity analyses were also conducted. Results This review included 17 RCTs. Women who received anesthesia had a significantly higher incidence of successful ECV (RR: 1.37, 95% CIs: 1.19-1.58) and vaginal delivery (RR: 1.23, 95% CIs: 1.03-1.47), and a significantly lower incidence of cesarean delivery (RR: 0.69, 95% CIs: 0.53-0.91), compared with those who did not. Conclusion The administration of anesthesia not only significantly reduces maternal pain but also significantly increases the success rate of ECV in women with malpresentation at term, leading to a significant rise in the incidence of vaginal delivery. However, it may increase the incidence of maternal hypotension. Systematic review registration The protocol was prospectively registered with PROSPERO, registration CRD42022381552.

Background: External cephalic version (ECV) is a medical procedure in which an extracorporeal manipulation is performed to render the breech presentation (BP) fetus in the cephalic position. The use of anesthesia to facilitate repositioning has been evaluated in various randomized clinical trials (RCTs), but its potential effectiveness remains controversial. Methods: A systematic literature search was carried out in 8 electronic databases. In the meta-analysis, a random effects model was used to calculate the pooled relative risk (RR) and its 95% confidence interval (CI), and the pooled standardized mean difference (SMD) and its 95% CI, in order to systematically assess the effect of anesthesia on the success rates of ECV, vaginal delivery, cesarean delivery as well as other outcomes. Relevant subgroup analyses, publication bias test and sensitivity analyses were also conducted. Results: This review included 17 RCTs. Women who received anesthesia had a significantly higher incidence of successful ECV (RR: 1.37, 95% CIs: 1.19-1.58) and vaginal delivery (RR: 1.23, 95% CIs: 1.03-1.47), and a significantly lower incidence of cesarean delivery (RR: 0.69, 95% CIs: 0.53-0.91), compared with those who did not. Conclusion: The administration of anesthesia not only significantly reduces maternal pain but also significantly increases the success rate of ECV in women with malpresentation at term, leading to a significant rise in the incidence of vaginal delivery. However, it may increase the incidence of maternal hypotension. Systematic review registration: The protocol was prospectively registered with PROSPERO, registration CRD42022381552. [ABSTRACT FROM AUTHOR]

Background: To determine the factors associated with successful external cephalic version (ECV) of breech presentation at term in China. Methods: Pregnant patients who underwent ECV for a breech presentation at term from January 2020 to January 2023 were included in this retrospective observational study. From the candidate demographic and clinical factors a logistic regression model was employed to detect the predictors of ECV success. A receiver operating characteristic (ROC) curve was constructed to test the discriminative capacity of the final model. Results: The success rate of ECV in 207 pregnancies with a breech presentation at term was 68.6%. The rates of failed ECV after four to five attempts were 45/207 (21.7%), and suspected foetal hypoxia was present in 7 out of 207 (3.38%) babies. Three factors—an increased amniotic fluid index (AFI), the use of terbutaline and lower head circumference to femur length (HC/FL) ratio predicted the probability of a successful ECV. The area under the ROC curve (c-statistics) was 0.735 (95% confidence interval (CI) 0.649–0.800). Conclusions: An increased AFI, use of terbutaline, and a lower HC/FL ratio were all associated with successful ECV and can be used to estimate the chances of ECV success. ECV for breech presentation is a safe procedure with a reasonable success rate which increases the likelihood of a vaginal birth.

Objective Our aim was to find the factors which predict a vertex presentation of vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV). Study Design This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis. Results A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI]: 3.90–7.52, p < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12–0.37, p < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI: 1.03–2.92, p = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model (p = 0.836). Conclusion Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor. Key Points The goal of ECV is to achieve a vertex VD. Predictors for ECV success might not predict a VD. Parity & AFI independently predict a VD after ECV. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the efficacy of remifentanil on external cephalic version (ECV) in breech presentation. An extensive search was conducted using PubMed, Cochrane Library, and other grey literature. Only randomized controlled trials using remifentanil for ECV were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes and quality of evidence was assessed using the Risk of Bias and GRADE system. Five studies consisting of 602 patients were analyzed. Remifentanil resulted in a moderate increase in ECV success rate (RR, 1.19; 95% CI, 1.00 to 1.43; P = .05), a large reduction of pain score (MD, -2.02; 95% CI, -2.32 to -1.72; P < .00001) with fewer transient fetal bradycardia (RR, 0.40; 95% CI, 0.19 to 0.85; P = .02). However, remifentanil did not affect cesarean section rates, (RR, 0.97; 95% CI, 0.49 to 1.93; P = .93) instrumental delivery (RR, 0.94; 95% CI, 0.41 to 2.15; P = 0.89), and spontaneous delivery rate (RR, 1.02; 95% CI, 0.78 to 1.35; P = 0.87). Mothers treated with remifentanil have a higher patient satisfaction score. The use of remifentanil may be a good strategy for ECV. However, extrapolation of this finding to clinical settings must consider the study limitations. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the factors associated with the success and failure rate of the external cephalic version (ECV) in breech fetuses. Secondary outcomes were fetal presentation in labor and mode of delivery. Methods: This cross-sectional study examined the live birth certificates from 2003 through 2020 from US states and territories that implemented the 2003 revision. A total of 149,671 singleton pregnancies with information about ECV success or failure were included. The outcome was ECV success/failure, while the exposures were possible factors associated with the outcome. Results: The successful ECV procedures were 96,137 (64.23%). Among the successful ECV procedures, the prevalence of spontaneous vaginal delivery was 71.63%. Among the failed ECV procedures, 24.74% had a cephalic presentation at delivery, but 63.11% of these pregnancies were delivered by cesarean section. Nulliparity, female sex, low fetal weight centile, high pre-pregnancy BMI, high BMI at delivery, and high maternal weight gain during pregnancy were associated with an increased ECV failure (p < 0.001). African American, American Indian and Alaska Native race categories were significant protective factors against ECV failure (p < 0.001). Maternal age had a U-shape risk profile, whereas younger maternal age (< 25 years) and old maternal age (> 40 years) were significant protective factors against ECV failure (p < 0.001). Conclusions: A high prevalence of successful ECV procedures and subsequent spontaneous vaginal delivery were found. The present results found nulliparity, maternal race, maternal age, female fetal sex, low fetal weight, and maternal anthropometric features correlated to ECV results. These findings can potentially improve the knowledge about the factors involved in ECV, allowing more informed counseling to the women undergoing this procedure. [ABSTRACT FROM AUTHOR]

Non-cephalic foetal positions account for about 3-4% of all timed deliveries. According to the recommendations of the Polish Socie-ty of Gynaecologists and Obstetricians on caesarean section, in the case of a non-cephalic position of the foetus in a singleton preg-nancy, the pregnant woman should be offered external cephalic version (ECV). ECV aims to achieve the head position of the foetus, using manual rotation performed through the abdominal shell, under constant ultrasound guidance. Before the procedure is per-formed, the pregnant woman undergoes the appropriate qualification, and factors that can affect the success or failure of the ECV attempt are analysed. As the literature indicates, to date, not all factors predisposing to the success or failure of the procedure have been recognised and unequivocally confirmed. Successful rotation and achievement of the foetal head position give pregnant women a chance to undergo vaginal delivery, potentially influencing a lower rate of elective caesarean sections.

• Breech presentation is a marker for undiagnosed uterine anomalies. • Ultrasound screening prior to external cephalic version for breech identifies previously undiagnosed or missed uterine anomalies. • Uterine anomalies identified by ultrasound in breech pregnancies allows timely counselling about interval management, interventions, delivery options and postpartum diagnosis and treatment. Uterine anomalies (UA) occur in up to 6.7% of women. Breech is eight times more likely to occur with UA which may not be diagnosed prior to pregnancy and may only be found in the third trimester with breech. The objective of the study is to assess the prevalence of both already known and newly sonographically diagnosed UA in breech from 36 weeks of gestation and its impact on external cephalic version (ECV), delivery options and perinatal outcomes. We recruited 469 women with breech at 36 weeks of gestation over a 2-year period at the Charité University Hospital, Berlin. Ultrasound examination was performed to rule out UA. Patients with known and newly ' de novo' diagnosed anomalies were identified and delivery options and perinatal outcomes analyzed. The ' de novo' diagnosis of UA at 36–37 weeks of pregnancy with breech was found to be significantly higher compared to the diagnosis prior to pregnancy with 4.5% vs 1.5% (p < 0.001 and odds ratio 4 with 95% confidence interval 2.12–7.69). Anomalies found included 53.6% bicornis unicollis, 39.3% subseptus, 3.6% unicornis and 3.6% didelphys. A trial of vaginal breech delivery was successful in 55.5% of cases when attempted. There were no successful ECVs. Breech is a marker for uterine malformation. Diagnosis of UA with breech can be up to four times improved with focused ultrasound screening in pregnancy even from 36 weeks of gestation prior to ECV to identify missed anomalies. Timely diagnosis aids antenatal care and delivery planning. Importantly, definitive diagnosis and treatment can be planned postpartum to improve outcomes in future pregnancies. ECV plays a limited role in selected cases. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate predictive factors of successful external cephalic version (ECV) using regional anesthesia. Methods: In this retrospective study, we included women who underwent ECV at our center from 2010 to 2022. The procedure had been conducted using regional anesthesia and the administration of intravenous ritodrine hydrochloride. The primary outcome was the success of ECV, which was defined as the rotation from a non‐cephalic to a cephalic presentation. Primary exposures were maternal demographic factors and ultrasound findings at ECV. To determine predictive factors, we conducted a logistic regression analysis. Results: Of 622 pregnant women who underwent ECV, missing data on any variables (n = 14) were excluded and the remaining 608 were analyzed. The success rate during the study period was 76.3%. Multiparous women had significantly higher success rates than primiparous women (adjusted odds ratio [OR]: 2.06 [95% confidence interval (CI): 1.31–3.25]). Women with a maximum vertical pocket (MVP) of <4 cm had significantly lower success rates than those with 4 cm < MVP ≤6 cm (OR: 0.56 [95% CI: 0.37–0.86]). The non‐anterior placental location was associated with higher success rates than the anterior placental location (OR: 1.46 [95% CI: 1.00–2.17]). Conclusions: Multiparity, MVP >4 cm, and non‐anterior placental locations were associated with successful ECV. These three factors could be useful for patient selection for successful ECV. [ABSTRACT FROM AUTHOR]

Objective The external cephalic version (ECV) has been shown to lower the likelihood of cesarean section requirements among pregnant women with breech presentations. In the current study, we investigated the effectiveness and safety of ritodrine as a tocolytic for ECV. Methods A total of 407 pregnant women with breech presentations, who had no contraindications for ECV, were enrolled in this study. Multivariable logistic regression analyses were used to assess the impact of ritodrine use on the safety and efficacy of ECV. Results The overall success rate was 67.6%, and ritodrine use was associated with significantly higher odds of successful ECV after adjusting for confounders. Moreover, using ritodrine did not increase the risk of adverse effects, including temporary changes in fetal heart rate, need for elective or emergency cesarean section due to fetal distress during ECV, low Apgar scores, and perinatal mortality. Conclusion Our results suggest that using ritodrine as a tocolytic during ECV may increase the likelihood of ECV success and may not increase adverse perinatal outcomes.

To assess the quality and content of information regarding external cephalic version on YouTube. YouTube was searched using the phrase "external cephalic version" (ECV) to identify informative videos by two independent reviewers. Videos were included if: (1) in English; (2) available November 20, 2021; (3) related to ECV. Videos were excluded if: (1) duration exceeded 15 min; (2) target audience was not patients or the general public; (3) not in English; (4) were advertisements or news clips; (5) did not relate to ECV. The Global Quality Scale was used to assess overall quality of selected videos. A content score was developed based on guidelines from the American College of Obstetricians and Gynecologists. Video quality was also categorized as "slightly useful", "useful" and "very useful". The Patient Education Materials Assessment Tool (PEMAT) for audiovisual materials was used to score understandability and actionability. Of 60 videos screened, 31 met inclusion criteria. They were classified as People or Blogs (n=19, 61%) or Education (n=12, 39%). Videos were calculated to be "slightly useful" (n=10, 32%), "useful" (n=18, 58%), or "very useful" (n = 3, 10%). The PEMAT – understandability was less in the "slightly useful" compared to the combined "useful" and "very useful" groups, p<0.01. No differences existed between total usefulness score and category, p=0.6. Most videos were useful, but few were very useful. These results highlight the importance of thorough counseling regarding this procedure. [ABSTRACT FROM AUTHOR]

External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. Following ECV, fetal well-being is assessed via a non-stress test (NST). An alternative option to identify signs of fetal compromise is via the Doppler indices of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). Inclusion criteria were an uncomplicated pregnancy with breech presentation at term. Doppler velocimetry of the UA, MCA and DV were performed up to 1 h before and up to 2 h after ECV. The study included 56 patients who underwent elective ECV with a success rate of 75%. After ECV, the UA S/D ratio, UA pulsatility index (PI) and UA resistance index (RI) were increased compared to before the ECV (p = 0.021, p = 0.042, and p = 0.022, respectively). There were no differences in the Doppler MCA and DV before or after ECV. All patients were discharged after the procedure. ECV is associated with changes in the UA Doppler indices that might reflect interference in placental perfusion. These changes are probably short-term and have no detrimental effects on the outcomes of uncomplicated pregnancies. ECV is safe; yet it is a stimulus or stress that can affect placental circulation. Therefore, careful case selection for ECV is important. [ABSTRACT FROM AUTHOR]

This report describes the case of a pregnant woman who arrived for preanesthetic assessment of External Cephalic Version (ECV) for fetus in breech presentation and cesarean section in case of ECV failure. Although the technique seems simple, attempts to rotate the fetus can result in elevated intracranial pressure, which might cause malformation bleeding. The most appropriate anesthetic technique in cases of arteriovenous malformations during C-sections has not been determined. Neuroaxial anesthesia is safe only in stable brain cavernomas, but the presence of spinal malformations contraindicates it. Anesthetic goals include stabilizing the blood pressure and reducing the risk of rupture.

Introduction: Several adjuvant interventions have been evaluated for improving the success rate of the external cephalic version (ECV) and reducing the rate of cesarean delivery (CD). Evidence regarding the effect of Nitrous oxide is limited to a small number of participants with inconsistent results on pain score and success rate. This study aims to examine the effect of inhaled nitrous oxide on the success rate and pain score for women undergoing ECV. Material and methods: Survey on ECV reports from inception till June 2020 were made from MEDLINE, EMBASE, PubMed, Ovid Medline, ClinicalTrials.gov, the Cochrane Library and Google Scholars. Peer-review studies that examined the success rate of ECV from the application of nitrous oxide during ECV attempts compared with or without the use of other analgesic agents were obtained. The study population comprising women with singleton pregnancies having a non-vertex presentation at least 36 weeks, were categorized into one of two treatment groups: ECV attempt with nitrous oxide (nitrous oxide group) and ECV attempt with or without another analgesia (control group). The primary outcome was the ECV success rate, defined by conversion to vertex-presentation following the procedure. The secondary outcomes were pain scores during ECV attempt and CD rate. The study quality scores were evaluated as a source of heterogeneity by fitting meta-regression models to the individual study effect sizes. Results: Of the 26 records identified, two randomized trials and one prospective cohort study (720 women; 434 in the nitrous oxide group and 286 controls) were deemed adequate for meta-analysis. ECV success rate did not differ significantly between the nitrous oxide group and the control group (p =.825; OR 1.036; 95% CI, 0.756, 1.419). In addition, the use of nitrous oxide did not affect pain scores during ECV attempt (p =.457; OR 0.759; 95% CI, −1.240, 2.759) and there was no difference in the incidence of CD as well (p =.943; OR 1.013; 95% CI, 0.703, 1.46). Conclusion: The use of nitrous oxide during ECV attempts was not associated with an increase in ECV success rate and does not affect pain scores. PROSPERO Registration No. CRD42020197933 [ABSTRACT FROM AUTHOR]

Purpose: External cephalic version (ECV) is an effective procedure to reduce the breech presentation at term reducing the chances of cesarean section. However even after successful ECV reports suggests the risk of having a cesarean section is high. The study analyzes the mode of delivery after a successful ECV and to identify the factors associated with intrapartum cesarean delivery compared to those with spontaneous cephalic presentation. Methods: This study was based on labor and delivery details, from the ECV registers, of 430 women who had successful ECV and they compared to those with spontaneous cephalic presentation. Primary outcome was delivery by cesarean section. Multiple logistic regression model was used to assess independent association of frisk factors associated with intrapartum cesarean section delivery by cesarean section and were presented as Odds Ratio (OR) and 95% confidence interval. Results: Cesarean section rates were similar among those who had a successful ECV and those with spontaneous cephalic presentation (22.3% vs 20.1%, p = 0.298). Women who had a successful ECV (OR = 1.5; (95%CI 1.13–1.98), maternal age (OR1.06–1.03–1.09), and previous delivery by cesarean section (OR = 5.16 (95%CI; 1.88–14.16) were found to associated with intrapartum cesarean section after adjusting for other factors. Conclusion: Women who had a successful ECV had an increased risk of intrapartum cesarean section compared those women with spontaneous cephalic presentation. Further research should be performed to identify more risk factors, which could optimize intra-partum care to reduce the risk of cesarean section for women after successful ECV. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of external cephalic version (ECV) in Portuguese public hospitals with maternity services, as well as exploring the main motives for not offering the technique. Methods: A cross‐sectional observational study was conducted involving an online survey with 34 questions, accessed via an email addressed to all Heads of Department of Portuguese state‐owned hospitals with maternity services. In centers where the technique was performed, information was requested on success rates, contraindications for the procedure, and practical aspects related to its use. In centers where ECV was not offered, the underlying reasons for this were queried. Results: Answers were received from 41 out of the 43 state hospitals with maternity services (95.3%). Sixteen hospitals perform the technique (39%), with reported annual numbers ranging from 3 to 51, and success rates ranging from 25% to 85% (12 respondents). The main reasons for not offering the technique were lack of experience and lack of conditions to perform it safely. Most centers (87.8%) reported that they would welcome hands‐on training in ECV. Conclusion: ECV is used in a minority of Portuguese state‐owned hospitals. Efforts are needed to achieve a wider implementation of the technique, with a particular focus on simulation‐based training. External cephalic version is used in a minority of Portuguese public hospitals. Efforts are needed in order to achieve a wider dissemination of the technique. [ABSTRACT FROM AUTHOR]

Background and Objectives: In recent years, the rate of caesarean section (CS) has increased constantly. Although vaginal breech delivery has a long history, breech presentation has become the third most common indication for CS. This study aims to identify factors associated with the success of external cephalic version (ECV), underline the success rate of ECV for breech presentation and highlight the high rate of vaginal delivery after successful ECV. Material and Methods: This retrospective observational study included 113 patients with singleton fetuses in breech presentation, who underwent ECV from January 2016 to March 2021 in the Clinic of Obstetrics and Gynecology, Diakonieklinikum Schwäbisch Hall, Germany. Maternal and fetal parameters and data related to procedure and delivery were collected. Possible predictors of successful ECV were evaluated. Results: The success rate of ECV was 54.9%. The overall rate of vaginal birth was 44.2%, regardless of ECV outcome. The vaginal birth rate after successful ECV was 80.6%. Overall, 79.0% of women with successful ECV delivered spontaneously without complications, 19.4% delivered through CS performed during labor by medical necessity, and 1.6% delivered through vacuum extraction. ECV was performed successfully in three of the four women with history of CS. Gravidity, parity, maternal age, gestational age, fetal weight, and amniotic fluid index (AFI) were significantly correlated with the outcome of ECV. Conclusions: ECV for breech presentation is a safe procedure with a good success rate, thus increasing the proportion of vaginal births. Maternal and fetal parameters can be used to estimate the chances of successful ECV. [ABSTRACT FROM AUTHOR]

BACKGROUND: In twin pregnancies where the presenting twin is not cephalic, cesarean delivery is the standard of care. External cephalic version (ECV) has been used for malpresenting singleton pregnancies with low risk of complications. ECV in twin pregnancies is poorly studied. OBJECTIVE: To assess feasibility and report any complications of ECV of a malpresenting twin before labor. STUDY DESIGN: This is a prospective cohort of twin pregnancies with malpresenting first twin. Inclusion criteria included English or Spanish speaking women. Exclusions included cases where there was a contraindication to vaginal delivery. ECV was performed according to the institutional singleton protocol. Fetal testing of both twins was performed before and after procedure. A vaginal hand was used during ECV as needed. The primary outcome was success of the procedure. Secondary outcomes included delivery characteristics and neonatal outcomes. RESULTS: Five patients were enrolled in this study. Four patients underwent successful ECV and vaginal delivery occurred in 2 of the 4 patients. ECV procedure was performed at a mean gestational age of 36+0 weeks in the successful ECV group and 36+6/7 weeks for the unsuccessful group. Latency to delivery was 4.5 days in the successful ECV group and 1 day in the unsuccessful ECV group. No maternal or neonatal complications occurred in any participating women. CONCLUSION: ECV in twin pregnancies where the first twin is malpresenting was feasible in our cohort. More research is needed to better characterizer the safety and efficacy of this procedure in this patient population.

Objective: To investigate if a hospital‐initiated home‐based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth. Design A multicentre randomised controlled trial. Setting: Three university hospitals in Copenhagen, Denmark. Population: Pregnant women with a breech or transverse presentation at 35 weeks or more of gestation eligible for ECV. Methods: We compared rebozo before ECV with ECV alone. The randomisation was computer‐generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3–5 days before the scheduled ECV. Analyses were by intention‐to‐treat. Main outcome measure: The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n = 187) or control (n = 185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40–0.95). No adverse events were observed in relation to the intervention. Conclusions: In breech or transverse presentation, home‐based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth. Home‐based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth. Home‐based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth. [ABSTRACT FROM AUTHOR]

Background: External cephalic version (ECV) is a technique used to reduce the incidence of cesarean deliveries due to malpresentation. Nitrous oxide is an inhaled analgesic that may be used for pain relief for women undergoing external cephalic version.Objective: To compare the conversion rate of non-cephalic to cephalic presentation in ECV with and without nitrous oxide.Study Design: A retrospective cohort analysis was performed including all singleton, term gestation ECVs between January 2016 and June 2017 at a single institution. Multivariable logistic regression was used to compare women who had ECV with nitrous oxide versus ECV without nitrous oxide. The primary outcome was successful rate of conversion to cephalic presentation and the secondary outcome was the rate of vaginal delivery.Results: During the study period, 167 women underwent ECV: 77 with nitrous oxide and 90 without nitrous oxide. Of the 77 women who used nitrous oxide, 25 (32.5%) were successful and 17 of these women delivered vaginally (68%). Of the women who underwent ECV without nitrous oxide, 29 (32.2%) successfully converted and 21 of these delivered vaginally (72%). After controlling for confounders, the use of nitrous oxide had no clinically or statistically significant difference on ECV success rates (OR 1.08, 95% CI 0.52-2.23).Conclusion: Nitrous oxide does not seem to affect conversion rate to cephalic presentation in ECV. Further studies are needed to determine the impact of nitrous oxide on women's decision to undergo ECV and on patient satisfaction and tolerability. [ABSTRACT FROM AUTHOR]

Objective: Decreasing the primary cesarean delivery rate and associated maternal and fetal complications is a priority for obstetric care providers. External cephalic version (ECV) is a procedure recommended for women with singleton pregnancies where the fetus is malpresenting to avoid vaginal breech delivery, which is inherently riskier than cesarean delivery. However, little is known about this procedure in the context of twin gestations. Scheduled cesarean delivery is instead recommended for women with twin gestations where the presenting twin is not cephalic. Our aim is to evaluate the safety and efficacy of ECV in the setting of twin pregnancy where the presenting twin is not cephalic. We also present two patients with twin pregnancy at our institution that attempted ECV.Data Sources: A systematic review of the following electronic databases was performed, searching from their inception until September 2019: Pubmed, Ovid, Scopus, and clinicaltrials.gov.Study Eligibility Criteria: All reported cases of ECV for a non-cephalic presenting twin were included. Studies were excluded if patients had contraindications to vaginal delivery and if they described ECV of the second twin only. Maternal demographics, procedure details, and outcomes data were collected.Study Appraisal and Synthesis Methods: The primary outcome was a successful version of the presenting twin to the cephalic presentation following ECV. Statistical analysis involved calculating means, standard deviations, frequencies and percentages as appropriate.Results: Two case reports and one case series, totaling 22 patients, met inclusion criteria. Two additional patients attempted ECV at our institution. One completed ECV (for a total of 23 patients) while the other did not. This patient consented for ECV as Twin A was noted to be breeched upon presentation to labor and delivery but after receiving regional anesthesia, twin A was cephalic. No randomized controlled trials were identified. All were dichorionic pregnancies. Successful ECV of twin A occurred in 57% (13/23) of women and 48% (11/23) had a successful vaginal delivery. The majority were performed using regional anesthesia and a uterine relaxant (20/23). No serious adverse events occurred in any of the reports.Conclusions: ECV is insufficiently studied in twin pregnancy. Based on very limited data, it appears feasible to turn the non-cephalic presenting twin. Additional randomized controlled trials are needed to further evaluate the safety and efficacy of this procedure for a non-cephalic presenting twin. [ABSTRACT FROM AUTHOR]

Objectives: The cross-sectional survey was conducted aiming to evaluate the knowledge and experiences of the Polish obstetricians and gynecologists regarding the External Cephalic Version (ECV) and investigate their practices concerning this procedure., Material and Methods: An online survey constituting author-created questionnaire with 22 questions, was distributed among gynecologists and obstetricians. The questionnaire evaluated participants' knowledge about ECV, work experiences, and workplace practices., Results: Out of 461 respondents, 56.20% were specialists in gynecology and obstetrics. Elective cesarean section (CS) was preferred by 78.70% for primiparas and 73.50% for multiparas with non-cephalic presentation, while ECV would be chosen by 21.3% and 23.6%, respectively. While 73.80% knew centers performing ECV, only 16.70% had actively participated in the procedure. Major differences in the experiences and knowledge regarding ECV were observed based on work experience, and workplace reference level. Experienced physicians showed higher concerns about ECV complications and emergency CS risks. The most common concerns regarding the procedure referred to periprocedural pain, perceived low efficacy, and complications, and were more prevalent among respondents with longer experience and from lower-reference centers., Conclusions: The study demonstrated that among Polish obstetricians for term pregnancies with non-cephalic presentation, elective cesarean section is preferred over ECV, especially among experienced practitioners. Knowledge about ECV was relatively low, indicating a need for improved educational efforts. Addressing concerns about ECV's safety and efficacy, particularly through enhanced training and anesthesia options, could promote its adoption and reduce CS rates.

Objectives: The primary objective is to identify our local external cephalic version (ECV) success rate, variables associated with increased likelihood of success, and complication rates. The secondary objective is to allow obstetrical care providers to accurately counsel patients undergoing a trial of ECV., Methods: We analysed patient charts between January 2018 and December 2022 who underwent ECV. Variables included maternal age, parity, gestational age at the time of ECV attempt, breech type, anesthetic, uterine relaxant, placental location, neonatal birthweight, and provider seniority. Outcomes were ECV success, mode of delivery, emergent cesarean delivery rate due to ECV, and neonatal intensive care unit admission. Appropriate statistical analysis was performed., Results: Overall, 258 patients were included. Overall success rate was 31%. Multiparity, transverse presentation, and neonatal birthweight >3.3 kg were associated with significantly increased success rates. Uterine relaxant use was associated with a lower success rate than no relaxant use, which is potentially explained by significantly more frequent relaxant use in non-transverse presentations and a non-significant trend in increased relaxant use in primiparous patients. Other factors including anesthetic use, maternal age, gestational age, placental location, and provider seniority did not significantly impact success. The emergency cesarean delivery rate was 10% and the neonatal intensive care unit admission rate was 8%, both of which were higher than anticipated., Conclusions: ECV remains an option for the management of the term breech. Obstetrical providers at our centre and in others may use this study to more accurately counsel patients using local data and optimize the likelihood of success based on patient and peri-procedural factors., (Copyright © 2024 The Author. Published by Elsevier Inc. All rights reserved.)

Racial and ethnic disparities in obstetrics are prevalent in the United States (US). We aimed to assess whether the success rate of external cephalic version (ECV) is affected by maternal race/ethnicity. We conducted a retrospective analysis based on the CDC Natality Live Birth database for 2016–2018. We compared the success rates of ECV across US pregnant women of different racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asians, and Hispanics) using the Pearson chi-square test and used multivariate logistic regression to control for confounding variables. Statistical signiciance was determined as p<0.05 and results were displayed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Of the 11,150,527 births, 26,255 women underwent an ECV and met inclusion criteria. The overall ECV success rate was 52.75% (13,850 women). Non-Hispanic Blacks had the highest ECV success rate (64.52%), followed by Hispanics (59.21%) and non-Hispanic Asians (55.51%). These rates were significantly higher than those of non-Hispanic Whites (49.27%, p<0.001). Non-Hispanic Blacks were associated with the highest success rate compared to non-Hispanic Whites (adjusted OR 1.95, 95% CI 1.77–2.15). The success rate of ECV varies among different maternal racial/ethnic groups. Non-Hispanic White women have the lowest ECV success rate, while non-Hispanic Black women have the highest ECV success rate. [ABSTRACT FROM AUTHOR]

Introduction: Short-term maternal administration of betamimetics is a common obstetric practice with uses including tocolysis during antenatal corticosteroid administration for fetal lung maturity, intrapartum tachysystole, and prior to external cephalic version. While previous research has demonstrated adverse effects of prolonged use of maternal betamimetics, no prior documentation exists of fetal tachyarrhythmias beyond sinus tachycardia after administration of terbutaline. Case: This case documents a transient fetal tachyarrhythmia consistent with presumed atrial flutter after maternal administration of terbutaline for external cephalic version. On day of life 9, the neonate presented in supraventricular tachycardia with signs of heart failure and was subsequently diagnosed with Wolff-Parkinson-White syndrome. Conclusion: Maternal administration of terbutaline may be associated with transient fetal tachyarrhythmia. In some fetuses, this cardiac arrhythmia may predate diagnosis of an underlying cardiac disorder, warranting close follow-up after delivery.

Introduction: Success rates of external cephalic version (ECV) are heterogenous in the published literature. Some individual factors are already known to be associated with ECV success but probably do not fully explain the differences. The objective of this review is to assess the association between hospitals' cesarean delivery rates for breech presentations after ECV failure and their ECV success rates.Material and Methods: We performed a review of the literature using the Medline and Cochrane Library computer databases and by searching on clinicaltrials.gov, from 1985 through 2020. This analysis included all studies reporting ECV success rates and cesarean delivery rates for breech presentations. The prognostic factors for successful ECV, such as rates of nulliparity, gestational age at ECV, BMI, and tocolysis use, were also collected and analyzed. Median ECV success rates from the included studies were compared according to these factors. The cesarean rate for persistent breech presentation after ECV failure reported in these studies was considered a proxy indicator of the unit's policy for breech presentations. The correlation between ECV success rates and cesarean delivery rates was analyzed and is presented as a scatter plot.Results: This analysis included 22 studies reporting rates of both successful ECV and cesarean deliveries for persistent breech presentation after ECV failure. The ECV success rates ranged from 16.3% to 82.5% with a median of 48.8% (interquartile range: 36.9-62.9). The median ECV success rate was higher in the studies that used tocolysis than in those that did not (51.3% versus 22.0%, P = .001) and in the studies with the highest cesarean rates for breech presentations than in those with the lowest cesarean rates (57.9% versus 36.2%, P = .006). The ECV success rates were significantly correlated with cesarean delivery rates for persistent breech presentations (R = 0.67; P = .001).Conclusion: The likelihood of successful ECV appears higher in hospitals with policies that generally result in cesarean delivery for persistent breech presentation. [ABSTRACT FROM AUTHOR]

External cephalic version (ECV) is the manipulation of the fetus presented in breech or transverse position, through the maternal abdomen, to a cephalic presentation, so as to avoid the adverse outcome for the mother and child during vaginal delivery of the breech or transverse fetal position. ECV is a safe and effective procedure to reduce cesarean delivery rates. ECV has been gradually applied to pregnant women with contraindications of ECV, such as cesarean section. A history of cesarean section did not affect the success rate of ECV, compared with no history of cesarean section, maternal and neonatal complications such as abnormal fetal heart rate, vaginal bleeding, premature rupture of membranes, emergency cesarean section, and poor neonatal prognosis were not increased. A previous cesarean delivery may not increase the risk of scar dehiscence or rupture during ECV. Parity is an important factor affecting the success rate of ECV. The majority of women with a previous cesarean delivery will have a successful vaginal birth after a successful ECV, but the rate of vaginal delivery is lower than that of women without a previous cesarean delivery. To promote a vaginal delivery and improve the obstetrics quality, ECV can be offered carefully to women with a breech presentation and a previous cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To develop prediction models for the chance of successful external cephalic version (ECV) and delivery outcome. Study design: This is a single-center retrospective study including 350 pregnant women with a singleton non-cephalic pregnancy at or after 36 weeks of gestational age. We selected 22 factors for ECV prediction and 21 for delivery outcome after successful ECV prediction as candidate predictors. Multivariable logistic regression with a stepwise backward selection procedure was used to construct a prediction model for the chance of successful ECV and the other for the delivery outcome. The discrimination and calibration of the models were assessed and internal validation was done with bootstrapping. Results: ECV was successfully performed in 232 cases (66.3%) among 343 women. Eight predictive factors were identified to be associated with a successful ECV: Gestational week at ECV < 39 weeks, multiparous, BMI before pregnancy < 22 kg/m3, palpable fetal head, breech engagement, larger AFI, larger BPD and posterior placenta. This model showed good calibration and good discrimination (c-statistic = 0.82, 95% CI 0.76–0.88). Six predictive factors were identified to be associated with vaginal delivery after successful ECV: age < 35, multiparous, BMI before pregnancy < 22 kg/m3, anterior placenta, lateral placenta and none-front fetal spine position. This model showed fair discrimination (c-statistic = 0.79, 95% CI 0.72–0.85). However, its calibration was not so satisfactory especially when the predicted probability was low. Conclusion: We validated a prediction model for ECV and delivery outcome, showing that the model's overall performance is good. This can be used in clinical practice after external validation. [ABSTRACT FROM AUTHOR]

Objectives: To assess the feasibility of external cephalic version (ECV) for the leading twin (twin A) in breech presentation in dichorionic and diamniotic twin pregnancies without the use of regional anesthetics and tocolysis and to characterize the sonographic parameters, maternal and neonatal outcomes.Study Design: Prospective study performed in the Charité University Hospital outpatient obstetric department in Berlin, Germany. A total of 23 women from the 35th completed week of pregnancy with confirmed dichorionic-diamniotic twin pregnancy were recruited. ECVs were performed by the lead consultant for the breech and ECV clinic. Ethical approval provided by the Charité Ethics Commission (EA2/241/18). Demographic data were recorded. Fetal sonographic parameters were assessed. The success rate of ECV, duration of the ECV, gestational age at delivery, mode of delivery for both fetuses, maternal and neonatal outcomes were analyzed.Results: Our main finding showed that ECV for twin A breech in dichorionic-diamniotic twins is successful in 56% (10/18) of cases without the need for regional anesthesia and without tocolysis. There is a significant increase in the spontaneous vaginal delivery rate for both twins of 95% (19/20) vs 12.5% (2/16) (p < 0.001). There is also a significant reduction in blood loss at delivery of 300 ml vs 500 ml (p = 0.034) in successful cases.Conclusions: We show that ECV for twin A in breech is feasible and in 56% (10/18) successful without regional anesthesia and tocolysis. The option of ECV for twin A breech should be offered to women. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of atosiban versus ritodrine as tocolytics in external cephalic version (ECV).Materials and Methods: A prospective comparative trial was carried out in a tertiary hospital. 430 women with singleton breech pregnancies ≥36 weeks were recruited for ECV, 215 with ritodrine and 215 with atosiban as tocolytic agents. The efficacy, complications and perinatal outcomes were compared between both groups. The associations between variables were analyzed using the chi-square test (χ2) (qualitative), Student's t test (quantitative, parametric) or Mann-Whitney test (nonparametric). Statistical significance was established as p < .05.Results: The overall ECV success rate was 47.9% (206/430), 46.0% in the atosiban group (99/215) and 49.8% in the ritodrine group (107/215). This difference showed no statistical significance (p = .440). A higher rate of uterine contractions after the maneuver was observed in the atosiban group (34.4 versus 22.8%; p = .008), but without clinical relevance. Perinatal outcomes were similar in both groups, with no significant differences.Conclusion: Atosiban and ritodrine showed similar efficacy as tocolytic agents in ECV, with no differences in complications and perinatal outcomes between these two agents. [ABSTRACT FROM AUTHOR]

Background: To determine whether neuraxial anesthesia (NA) can improve the success rate of external cephalic version (ECV), and evaluate the clinical outcomes. Methods: This study included 201 consecutive participants who had a breech presentation at term and received ECV between 2014 and 2022. Participants who received ECV without NA were included in Group 1, while participants with NA were included in Group 2. Outcomes assessed were the success rate of ECV and clinical outcomes. Results: In total, 201 participants who had a breech presentation at term and received ECV met the inclusion criteria. Totally, 134 participants performed ECV without NA were included in Group 1, while 67 participants performed the ECV with NA were included in Group 2. The success rate of ECV among the participants was 66.2% (133/201). The rate of placental abruption during or after ECV and neonatal intensive care unit (NICU) admission in Group 2 was statistically significant higher than in the Group 1 (p < 0.05). Conclusions: This study suggested that the use of NA did not increase ECV success rates after 37 weeks of gestation. The recommendation of NA for the ECV may be not suitable for all pregnancies unless the participants request. A large and high-quality study should be conducted to verify the role of NA in ECV, if any.

External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. Following ECV, fetal well-being is assessed via a non-stress test (NST). An alternative option to identify signs of fetal compromise is via the Doppler indices of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV). Inclusion criteria were an uncomplicated pregnancy with breech presentation at term. Doppler velocimetry of the UA, MCA and DV were performed up to 1 h before and up to 2 h after ECV. The study included 56 patients who underwent elective ECV with a success rate of 75%. After ECV, the UA S/D ratio, UA pulsatility index (PI) and UA resistance index (RI) were increased compared to before the ECV (p = 0.021, p = 0.042, and p = 0.022, respectively). There were no differences in the Doppler MCA and DV before or after ECV. All patients were discharged after the procedure. ECV is associated with changes in the UA Doppler indices that might reflect interference in placental perfusion. These changes are probably short-term and have no detrimental effects on the outcomes of uncomplicated pregnancies. ECV is safe; yet it is a stimulus or stress that can affect placental circulation. Therefore, careful case selection for ECV is important.

Introduction: The aim of this study was to evaluate the impact of women's body mass index (BMI) on the probability of a successful external cephalic version (ECV).Material and Methods: A retrospective population-based observational study including all women that underwent an ECV in the southeast region of Sweden from January 2014 to December 2019. Data were collected from electronic medical records, Obstetrix, Cerner. The women were divided into BMI categories according to the World Health Organization classification. Women with a BMI below 25 kg/m2 formed the reference group. Crude and adjusted odds ratios for unsuccessful ECV in each BMI group were calculated using binary logistic regression. Furthermore, the association between maternal characteristics and clinical and ultrasound variables at the time of the ECV and unsuccessful ECV was evaluated.Results: A total of 2331 women were included. The overall success rate of ECV was 53.4%. Women with a BMI below 25 kg/m2 had a success rate of 51.3% whereas obese women had a success rate of 58.6%. The risk of an unsuccessful ECV among obese women (BMI ≥30 kg/m2 ) had an OR of 0.74 (95% CI 0.59-0.94) compared with women with a BMI below 25 kg/m2 . After adjusting for suitable confounding factors, the association was no longer significant. Higher maternal age, multiparity, higher gestational age, posterior placenta position, polyhydramnios and higher estimated weight of the fetus at the ECV significantly decreased the risk of an unsuccessful ECV.Conclusions: Maternal obesity does not seem to negatively influence the success rate of ECV. This is a finding that may encourage both caregivers and obese pregnant women to consider an ECV and so avoid a planned cesarean section for breech presentation in this group. [ABSTRACT FROM AUTHOR]

Background: External cephalic version (ECV) is a common procedure and has been shown to be safe and effective in turning a baby from a breech to cephalic presentation. However, whether ECV is safe and effective in women with a scarred uterus from a previous caesarean section remains contentious. Aim: To evaluate the safety and efficacy of external cephalic version in women with a singleton breech pregnancy and at least one previous caesarean delivery. Material and methods: Literature searches were conducted on MEDLINE, PUBMED, EMBASE, CINAHL and SCOPUS up to June 2020. The search strategy included the following keywords: ('external cephalic version OR ECV') AND ('previous OR prior OR past' AND 'caesarean OR caesarean OR uterine scar'). Studies were included if they evaluated the efficacy and/or safety of external cephalic version in women after 36 weeks' gestation with a singleton breech pregnancy and at least one previous caesarean delivery. Results: Nine studies were included in the review. ECV success rates and subsequent vaginal delivery rates ranged from 50 to 100% and from 50 to 74.9%, respectively. ECV complications reported included abnormal fetal heart rate, abnormal cardiotocography and transient vaginal bleeding. No studies reported cases of uterine rupture. Conclusions: ECV in women with a previous caesarean delivery is a relatively successful and low‐risk procedure compared to women without a previous caesarean delivery. The results from this systematic review provide useful information for professional bodies in updating clinical guidelines such that ECV may be offered to women with one previous caesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA).Methods: Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra- and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using Bland-Altman analysis. Student's t-test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements.Results: Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80-0.93) and 0.83 (95% CI, 0.71-0.90), respectively. The mean difference between measurements was 0.4° (95% CI, -1.4 to 2.2°) for intraobserver repeatability and -0.4° (95% CI, -2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9-15.1°) and 13.6° (95% CI, 9.9-17.3°) for intra- and interobserver repeatability, respectively. The lower limits of agreement were -11.2° (95% CI, -14.3 to -8.1°) and -14.4° (95% CI, -18.2 to -10.7°) for intra- and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra- or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- or interobserver reliability.Conclusions: BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]