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External cephalic version with an amniotic fluid index < or = 10: a systematic review
David M Haas1, Everett F Magann
1Department of Obstetrics and Gynecology, Naval Hospital, Camp Lejeune, NC 28547, USA. dahaas@iupui.edu
Summary
The amniotic fluid index (AFI) may impact external cephalic version (ECV) success. Lower AFI levels, though not statistically significant, appear correlated with reduced ECV success rates.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatology
Background:
- External cephalic version (ECV) is a procedure to turn a breech fetus to a cephalic presentation.
- The amniotic fluid index (AFI) is a measure of amniotic fluid volume, crucial for fetal well-being and procedural success.
- The relationship between AFI and ECV success requires further clarification.
Purpose of the Study:
- To systematically review existing literature and assess the influence of the amniotic fluid index (AFI) on the success rates of external cephalic version (ECV).
Main Methods:
- A comprehensive literature search was performed using MEDLINE and Cochrane databases.
- Keywords included 'breech', 'version', 'external cephalic version', 'amniotic fluid', and 'amniotic fluid index'.
- Manual reference searches and inclusion of articles published between 1987 and 2004 were employed.
Main Results:
- Only three studies met the inclusion criteria after initial screening of 33 articles.
- The studies utilized varying AFI thresholds for low or borderline amniotic fluid, preventing meta-analysis.
- All included studies indicated a trend towards lower ECV success rates with decreased amniotic fluid volume (AFI 5-8, <10, or <8.6), but without statistical significance.
Conclusions:
- Limited and heterogeneous data preclude the establishment of a definitive lower AFI threshold for ECV success.
- An AFI below 10 may be associated with diminished ECV success, warranting further investigation.