External cephalic version of breech fetus after 36 weeks of gestation – evaluation of efectiveness and complications

Czech version

Authors: Lukáš Hruban ¹; Petr Janků ¹; K. Jordánová ¹; Romana Gerychová ¹; M. Huser ¹; P. Ventruba ¹; A. Roztočil ²
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba DrSc., MBA ¹; Gynekologicko-porodnické oddělení, Nemocnice Jihlava, primář prof. MUDr. A. Roztočil, CSc. ²
Published in: Ceska Gynekol 2017; 82(6): 443-449

Overview

Objective:
Evaluation of success rate and the safety of external cephalic version after 36 weeks of gestation.

Design:
Retrospective analysis.

Setting:
Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno.

Methods:
A retrospective analysis of external cephalic version attempts performed on a group of 638 singleton breech pregnancies after 36 weeks gestation in the years 2003–2016 at the Department of Gynecology and Obstetrics, Masaryk University, Brno. The effectiveness, number and type of complications, mode of delivery and perinatal result were observed.

Results:
The effectiveness of external cephalic version from breech to head presentation was 47.8% (305 cases). After a successful external cephalic version 238 patients (78.0%) gave birth vaginally. After unsuccessful cephalic version 130 patients (39.0%) gave birth vaginally. The number of serious complications did not exceed 0,9% and did not affect perinatal outcomes. External cephalic version-related emergency cesarean deliveries occurred in 6 cases (2 placental abruption, 4 abnormal cardiotocography). The fetal outcome was good in all these cases. The death of the fetus in connection with the external version has not occurred in our file. Spontaneous discharge of amniotic fluid within 24 hours after procedure occurred in 5 cases (0.8%). The spontaneous onset of labor within 24 hours of procedure occurred in 5 cases (0.8%). The pH value of a. umbilicalis < 7.00 occurred in 2 cases in the group with a successful external version and in the group with unsuccessful external version in 9 cases. The Apgar score in the 5th minute < 5 was both in the successful and unsuccessful group in 1 case.

Conclusion:
The external cephalic version of the fetus in the case of breech presentation after the 36th week of pregnancy is an effective and safe alternative for women who have a fear of the vaginal breech delivery. Performing the external cephalic version can reduce the rate of elective caesarean sections due to breech presentation at term.

Keywords:
external cephalic version, breech presentation, caesarean section

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