Is Fear of External Cephalic Version Well-founded?

Czech version

Authors: J. Nagy; E. Nyklová
Authors‘ workplace: Nemocnice Milosrdných bratří, Brno, přednosta prim MUDr. I. Huvar, CSc.
Published in: Ceska Gynekol 2008; 73(4): 254-260

Overview

Background and objective:
External cephalic version (ECV) is often denied due to fear of complications and pain during this procedure. The aim of this study was to assess maternal pain perception during ECV and to report the incidence of complications associated with this procedure.

Design:
Prospective study.

Setting:
Hospital of Merciful Brothers, Brno.

Methods:
Study included 110 women undergoing ECV. Pain was measured by visual analog scale (VAS) and descriptive part of Czech version of McGill Pain Questionnaire (MPQ). The overall pain rating index (PRI) and PRI of sensoric (S), affective (A), evaluating (E) and miscellaneuos (M) descriptors of pain was assesed. The assesment was performed in all patient and group of successful and failed ECV was compared by t-test. All complications during ECV were recorded. Incidence of operative deliveries after successful ECV was compared with control group included parturients with cephalic presentantion by odds ratio (OR) with 95% confidence interval (95%CI).

Results:
Forty two ECV (38%) was successful. Mean value of VAS was 4,9, PRI 14,4 (SD=1,9). PRI of particular qualities of pain: S= 8,0, A =1,9, E =2,6, M =2,1. The significant diference between successful and failed ECV group was in VAS (4,2 vs 5,4, p = 0,001) , PRI -A (1,3 vs 2,2, p = 0,018) and PRI-M (1,5 vs 2,5, p = 0,015). We recorded 2 (1,8%) cases of transient fetal bradycardia, 8 ECV (7%) was discontinued for pain and in 52% women after ECV transient decrease in fetal heart rate variability occured. No serious complication was recorded. The incidence of caesarean section after successful ECV was 21% and in control group 16% (OR 1,4 95%CI 0,62;3,01). Incidence of instrumental delivery after ECV was 12%, in control group 5% (OR 2,7 95%CI 0,93; 7,27).

Conclusion:
The pain during ECV was mild and well tolareted. The incidence of complications was small and the most of them were not serious. In this study no reasons for denying ECV were found.

Key word:
breech presentation, external cephalic version, complications, pain measurement.

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