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[External cephalic version using tocalytica (author's transl)].

M Meyenburg, W Busch

Zeitschrift Fur Geburtshilfe Und Perinatologie

|December 1, 1976

Summary

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External cephalic version (ECV) successfully converted breech presentations to cranial in 39 of 63 cases, significantly reducing cesarean delivery rates. Factors like uterine contractions and placental location influenced ECV success and risks.

Area of Science:

Obstetrics and Gynecology
Maternal-Fetal Medicine
Perinatal Surgery

Context:

Breech and transverse fetal presentations complicate approximately 3-4% of term pregnancies.
External cephalic version (ECV) is a procedure to manually turn the fetus from a non-cephalic to a cephalic presentation before labor.
Historically, ECV success rates have varied, with concerns regarding maternal and fetal risks.

Purpose:

To evaluate the efficacy and safety of external cephalic version in converting breech or transverse presentations to cephalic.
To assess the impact of ECV on cesarean delivery rates.
To identify factors influencing ECV success and complications.

Summary:

This study reports on 63 external cephalic versions performed between 35-40 weeks gestation.

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Success rates were 35% (22/63) with tocolytics alone and 50% (17/34) with general anesthesia.

Of the 39 successful ECVs, only two resulted in cesarean deliveries, a significant reduction compared to the 62% cesarean rate for breech presentations.

Failure to convert occurred in 24 cases due to uterine contractions, narrow amniotic cavity, maternal obesity, fetal position, or extended legs.

Complications included fetomaternal transfusion (6/22), suspected maternofetal transfusion, and one case of premature partial placental abruption, particularly with anteriorly located placentas.

Fetal heart rate decelerations occurred in 40% of cases, with two prolonged instances.

Five cesarean sections were performed post-ECV due to intra-uterine asphyxia, placental insufficiency, or abruption.

Impact:

Successful ECV significantly reduces the rate of cesarean deliveries for breech presentations.
Understanding factors influencing ECV success can optimize patient selection and procedural outcomes.
Awareness of potential complications, such as placental issues and fetal heart rate changes, is crucial for safe ECV practice.