Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): a prospective trial of vaginal breech versus cephalic delivery.

Reinhard, Joscha; Sänger, Nicole; Hanker, Lars; Reichenbach, Lena; Yuan, Juping; Herrmann, Eva; Louwen, Frank

Objective: To examine the delivery mode and neonatal outcome after a trial of external cephalic version (ECV) procedures. Study design: This is an interim analysis of an ongoing larger prospective off-centre randomised trial, which compares a clinical hypnosis intervention against neuro-linguistic programming (NLP) of women with a singleton breech foetus at or after 37 (259 days) weeks of gestation and normal amniotic fluid index. Main outcome measures were delivery mode and neonatal outcome. Results: On the same day after the ECV procedure two patients (2 %), who had unsuccessful ECVs, had Caesarean sections (one due to vaginal bleeding and one due to pathological CTG). After the ECV procedure 40.4 % of women had cephalic presentation ( n = 38) and 58.5 % ( n = 55) remained breech presentation. One patient remained transverse presentation ( n = 1; 1.1 %). Vaginal delivery was observed by 73.7 % of cephalic presentation ( n = 28), whereas 26.3 % ( n = 10) had in-labour Caesarean sections. Of those, who selected a trial of vaginal breech delivery, 42.4 % ( n = 14) delivered vaginally and 57.6 % ( n = 19) delivered via Caesarean section. There is a statistically significant difference between the rate of vaginal birth between cephalic presentation and trial of vaginal breech delivery ( p = 0.009), however, no difference in neonatal outcome was observed. Conclusion: ECV is a safe procedure and can reduce not only the rate of elective Caesarean sections due to breech presentation but also the rate of in-labour Caesarean sections even if a trial of vaginal breech delivery is attempted.

BREECH delivery; HYPNOTISM; CESAREAN section; MEDICAL statistics; AMNIOTIC liquid; NEUROLINGUISTIC programming; RANDOMIZED controlled trials

Archives of Gynecology & Obstetrics, 2013, Vol 287, Issue 4, p663

0932-0067

Academic Journal

10.1007/s00404-012-2639-1