The Early External Cephalic Version 2 Trial: An International Multicenter Randomized Controlled Trial of Timing of External Cephalic Version for Breech Pregnancies EDITORIAL COMMENT

Department of Obstetrics and Gynecology (Midwifery), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 02/2011; 118(5):564-77. DOI: 10.1111/j.1471-0528.2010.02837.x
Source: PubMed


To investigate whether initiating external cephalic version (ECV) earlier in pregnancy might increase the rate of successful ECV procedures, and be more effective in decreasing the rate of non-cephalic presentation at birth and of caesarean section.
An unblinded multicentred randomised controlled trial.
A total of 1543 women were randomised from 68 centres in 21 countries.
Women with a singleton breech fetus at a gestational age of 33(0/7) weeks (231 days) to 35(6/7) weeks (251 days) of gestation were included.
Participants were randomly assigned to having a first ECV procedure between the gestational ages of 34(0/7) (238 days) and 35(6/7) weeks of gestation (early ECV group) or at or after 37(0/7) (259 days) weeks of gestation (delayed ECV group).
The primary outcome was the rate of caesarean section; the secondary outcome was the rate of preterm birth.
Fewer fetuses were in a non-cephalic presentation at birth in the early ECV group (314/765 [41.1%] versus 377/768 [49.1%] in the delayed ECV group; relative risk [RR] 0.84, 95% CI 0.75, 0.94, P=0.002). There were no differences in rates of caesarean section (398/765 [52.0%] versus 430/768 [56.0%]; RR 0.93, 95% CI 0.85, 1.02, P=0.12) or in risk of preterm birth (50/765 [6.5%] versus 34/768 [4.4%]; RR 1.48, 95% CI 0.97, 2.26, P=0.07) between groups.
External cephalic version at 34-35 weeks versus 37 or more weeks of gestation increases the likelihood of cephalic presentation at birth but does not reduce the rate of caesarean section and may increase the rate of preterm birth.

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    • "This might be modified by performing ECV at an earlier stage in pregnancy, as has been described in the literature. However, the number of CS did not decrease despite higher ECV success rate [13]. We assume that nulliparous women might benefit most from early ECV intervention. "
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    ABSTRACT: Objective was to determine whether fear for external cephalic version (ECV) and depression are associated with the success rate of ECV in women with a breech presentation at term. Prospective study conducted in the Catharina Hospital Eindhoven between October 2007 and May 2012. Participants fulfilled The Edinburgh Depression Scale (EDS) questionnaire and expressed their degree of fear on a visual analogue scale from one to ten before ECV. Obstetric factors were evaluated as well. Primary outcome was the relation between psychological factors (fear for ECV and depression EDS scores) and ECV success rate. Secondary outcome was a possible relation between fear for ECV and increased abdominal muscle tension. Results The overall success rate was 55% and was significantly lower (p<0.001) in nulliparous women (44.3%) compared with parous women (78.0%). Fear for ECV and depression EDS-scores were not related with ECV success rate. Parity, placental location, BMI and engagement of the fetal breech were obstetric factors associated with ECV outcome. There was no relation between fear for ECV and abdominal muscle tone. Conclusion Fear for ECV and depression were not related with ECV success rate in this study. Engagement of the fetal breech was the most important factor associated with a successful ECV.
    BMC Pregnancy and Childbirth 03/2014; 14(1):101. DOI:10.1186/1471-2393-14-101 · 2.19 Impact Factor
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    • "ECV decreases the likelihood that the fetus will be in a noncephalic presentation at birth and the need for caesarean section [3–6]. Without contraindication, ECV should be recommended for all women with a breech fetus at term [3–6]; however, ECV is only successful in about 40% of attempts [4, 7–9]. "
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    ABSTRACT: Objective. To examine the effects of clinical hypnosis versus NLP intervention on the success rate of ECV procedures in comparison to a control group. Methods. A prospective off-centre randomised trial of a clinical hypnosis intervention against NLP of women with a singleton breech fetus at or after 370/7 (259 days) weeks of gestation and normal amniotic fluid index. All 80 participants heard a 20-minute recorded intervention via head phones. Main outcome assessed was success rate of ECV. The intervention groups were compared with a control group with standard medical care alone (n = 122). Results. A total of 42 women, who received a hypnosis intervention prior to ECV, had a 40.5% (n = 17), successful ECV, whereas 38 women, who received NLP, had a 44.7% (n = 17) successful ECV (P > 0.05). The control group had similar patient characteristics compared to the intervention groups (P > 0.05). In the control group (n = 122) 27.3% (n = 33) had a statistically significant lower successful ECV procedure than NLP (P = 0.05) and hypnosis and NLP (P = 0.03). Conclusions. These findings suggest that prior clinical hypnosis and NLP have similar success rates of ECV procedures and are both superior to standard medical care alone.
    Evidence-based Complementary and Alternative Medicine 06/2012; 2012(10):626740. DOI:10.1155/2012/626740 · 1.88 Impact Factor
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    • "Whilst ECV at term has been shown to be successful [2] ECV between 32-34 weeks is not successful and there is insufficient data regarding effectiveness of ECV between 34 and 36 weeks [3]. Recently reported findings from the Early ECV trial at 24-35 weeks versus 37 or more weeks reported an increased likelihood of cephalic presentation at birth but no reduction in the rates of caesarean delivery, or in the risk of preterm birth [4]. ECV may not be acceptable to all women [5], and some women express a preference for a vaginal birth [6-8], therefore there remains a need to examine the effectiveness and safety of other options of care. "
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    ABSTRACT: Moxibustion (a type of Chinese medicine which involves burning a herb close to the skin) has been used to correct a breech presentation. Evidence of effectiveness and safety from systematic reviews is encouraging although significant heterogeneity has been found among trials. We assessed the feasibility of conducting a randomised controlled trial of moxibustion plus usual care compared with usual care to promote cephalic version in women with a breech presentation, and examined the views of women and health care providers towards implementing a trial within an Australian context. The study was undertaken at a public hospital in Newcastle, New South Wales, Australia. Women at 34-36.5 weeks of gestation with a singleton breech presentation (confirmed by ultrasound), were randomised to moxibustion plus usual care or usual care alone. The intervention was administered over 10 days. Clinical outcomes included cephalic presentation at birth, the need for ECV, mode of birth; perinatal morbidity and mortality, and maternal complications. Feasibility outcomes included: recruitment rate, acceptability, compliance and a sample size for a future study. Interviews were conducted with 19 midwives and obstetricians to examine the acceptability of moxibustion, and views on the trial. Twenty women were randomised to the trial. Fifty one percent of women approached accepted randomisation to the trial. A trend towards an increase in cephalic version at delivery (RR 5.0; 95% CI 0.7-35.5) was found for women receiving moxibustion compared with usual care. There was also a trend towards greater success with version following ECV. Two babies were admitted to the neonatal unit from the moxibustion group. Compliance with the moxibustion protocol was acceptable with no reported side effects. Clinicians expressed the need for research to establish the safety and efficacy of moxibustion, and support for the intervention was given to increase women's choices, and explore opportunities to normalise birth. The sample size for a future trial is estimated to be 381 women. Our findings should be interpreted with caution as the study was underpowered to detect statistical differences between groups. Acceptance by women and health professionals towards moxibustion suggest further research is warranted. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000985280.
    BMC Complementary and Alternative Medicine 09/2011; 11(1):81. DOI:10.1186/1472-6882-11-81 · 2.02 Impact Factor
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