External cephalic version for breech presentation at term

External cephalic version (ECV) at term in breech presentation appears to reduce the chance of non-cephalic births and caesarean section and to be safe. Parenteral beta stimulants appear to to be effective for facilitating successful ECV.

Comment: The quality of evidence is downgraded by study limitations.

A Cochrane review included 28 studies involving a total of 2 786 women. Tocolytic parenteral beta stimulants vs placebo were effective in increasing cephalic presentations in labour and in reducing the number of caesarean sections. Failure to achieve a cephalic vaginal birth was less likely for women receiving a parenteral beta stimulant. No clear differences in fetal bradycardias were identified, although this was reported for only one study. Failed external cephalic version was less likely with beta stimulants. Perinatal mortality and serious morbidity were not reported. For other classes of tocolytic drugs (calcium channel blockers and nitric oxide donors), evidence was insufficient. Regional analgesia in combination with a tocolytic was more effective than the tocolytic alone for increasing successful versions (assessed by the rate of failed ECVs; average RR 0.61, 95% CI 0.43 to 0.86; 5 studies, n=409, moderate-quality evidence),

A meta-analysis of external cephalic version -related risk included 84 studies with 12 955 version attempts. The pooled complication rate was 6.1% (95% CI 4.7 to 7.8), 0.24% for serious complications (95% CI 0.17 to 0.34) and 0.35% for emergency cesarean deliveries (95% CI 0.26 to 0.47). Complications were not related to external cephalic version outcome (OR 1.2 (95% CI 0.93 to 1.7).

Another Cochrane review included 8 studies involving a total of 1 208. women. External cephalic version at term was associated with a significant reduction in non-cephalic births (RR 0.42, 95% CI 0.29 to 0.61; 8 trials, n=1 305) and caesarean section (RR 0.57, 95% CI 0.40 to 0.82; 8 studies, n=1 305). There was no significant effect on perinatal mortality (RR 0.39, 95% CI 0.09 to 1.64; 8 studies, n=1 305). There were no significant differences in the incidence of Apgar score ratings below seven at one minute (RR 0RR 0.67, 95% CI 0.32 to 1.37; 3 studies, n=168) or five minutes (RR 0.63, 95% CI 0.29 to 1.36; 5 studies, n=428), low umbilical artery pH levels, neonatal admission, nor time from enrolment to delivery.

Ədəbiyyat

1. Hofmeyr GJ, Kulier R. External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 1996;(1):CD000083 [Review content assessed as up-to-date: 28 February 2015].
2. Cluver C, Gyte GM, Sinclair M et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev 2015;(2):CD000184.
3. Grootscholten K, Kok M, Oei SG et al. External cephalic version-related risks: a meta-analysis. Obstet Gynecol 2008;112(5):1143-51.