1Specialist, Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital
2Associate Professor, Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital
3Professor & Head of Department, Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital
4Assistant Professor, Obstetrics & Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital
5Scientist F, National Institute of Medical Statistics, ICMR, New Delhi
6Ex DNB Student, Vardhman Mahavir Medical College & Safdarjung Hospital
7Chief Medical Officer (Senior Administrative Grade), Vardhman Mahavir Medical College & Safdarjung Hospital
*Corresponding author: Rekha Bharti, Specialist, Obstetrics & Gynaecology, VMMC & Safdarjung Hospital, New Delhi. E-mail: rekhabharti@gmail.com)
Online published on 27 March, 2014.
External cephalic version (ECV) is the only clinical intervention with level 1evidence for reducing rate of caesarean sections for breech presentation. The poor success of procedure at term is mainly due to engaged presenting part, foetal head not easily palpable and tense uterus.
To determine if beginning ECV earlier than term i.e. at 34–36 weeks is more effective than beginning ECV at term i.e. beyond 37 weeks and to study the factors that predict successful outcome of ECV.
Pregnant women with single live foetus in breech presentation at 34–35 weeks of gestation and willing to participate in the study were recruited. They were assigned randomly to ‘Early’ or ‘Late’ ECV group, after stratification for parity (nulliparous/multiparous) using random number table. In ‘Early’ ECV Group (Group1) ECV was done at 34+0 to 35+6 weeks and in ‘Late’ ECV Group (Group2) ECV was done at or after 37+0 weeks.
A total of 92 pregnant women were recruited in the study out of which final analysis was done for 38 women in ‘early ECV’ group and 42 women in ‘late ECV’ group. The success rate was higher in ‘early’ group compared to ‘late’ ECV group. There was 34% decrease in risk of non cephalic presentation in ‘early’ group (RR;95%CI 0.45;0.21–0.96, p=0.002). Success of ECV in early ECV group was associated with multiparity, lax abdominal tone and free floating breech (p=0.036, p<0.001 and p=0.002, respectively), whereas nonfrank breech, and easy palpability of head was associated with higher success rates in both ‘early’ and ‘late’ ECV groups. None of the women in ‘early’ or ‘late’ group went into preterm labour pains or had PROM. Transient foetal bradycardia was present in 5.3% women in ‘early’ ECV group and 16.7% women in ‘late’ ECV group, (p=0.159, RR;95%CI, 0.35;0.071.59).
ECV both ‘Early’ and ‘Late’ is a safe procedure, ‘Early ECV’ as compared to ‘Late’, has higher chance of success. Most significant predictors of success are free floating breech and easy palpable head followed by non frank breech.
Breech Pregnancy, External Cephalic Version, Predictors Of Success
