External cephalic version for singleton breech presentation: proposal of a practical check-list for obstetricians.

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Maternal-Fetal Medicine

Background:

• External cephalic version (ECV) is an obstetric procedure to externally manipulate a fetus from a breech to a cephalic presentation.
• ECV is not routinely performed by all obstetricians, potentially due to uncertainty regarding the relevance of various influencing factors.
• Standardized criteria for assessing ECV feasibility are lacking in many clinical settings.

Purpose of the Study:

• To assess the relevance of factors influencing the success and safety of external cephalic version (ECV).
• To develop a practical checklist for evaluating ECV feasibility based on identified factors.

Main Methods:

• A comprehensive review of 214 references was conducted.
• Factors affecting ECV success and risks were extracted and semi-quantitatively scored.
• Simple conjoint analysis was employed to determine the relevance of each factor.

Main Results:

• Parity emerged as the most significant factor for ECV feasibility (16.6%), followed by tocolysis (10.8%) and gestational age (10.6%).
• Other factors like amniotic fluid volume, breech variety, and placenta location showed lower relevance.
• Factors such as regional anesthesia, estimated fetal weight, and fetal position also play a role, albeit with varying degrees of importance.

Conclusions:

• External cephalic version (ECV) should be performed with caution, guided by a stringent checklist.
• The checklist should incorporate key factors including parity, tocolytic therapy, gestational age, and amniotic fluid volume.
• Additional considerations for the checklist include breech variety, placenta location, anesthesia, fetal well-being, and maneuverability.