Amnioinfusion for women with a singleton breech presentation and a previous failed external cephalic version: a...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• External cephalic version (ECV) is used to convert breech presentations to cephalic before labor.
• A second ECV attempt may be considered after an initial unsuccessful attempt.
• Amnioinfusion has been explored as an adjunct to ECV.

Purpose of the Study:

• To evaluate the effectiveness of amnioinfusion prior to a second external cephalic version (ECV) attempt.
• To determine if amnioinfusion increases the rate of cephalic presentation at delivery following an unsuccessful first ECV.

Main Methods:

• Open, randomized controlled trial with a sequential design.
• Recruitment of women at ≥36 weeks gestation with singleton breech presentation and a failed first ECV.
• Randomization to transabdominal amnioinfusion (500-mL saline) plus ECV or ECV alone, under ultrasound guidance.

Main Results:

• Trial stopped early due to recruitment difficulties; 119 women were randomized.
• No significant difference in cephalic presentation at delivery between amnioinfusion + ECV (20%) and ECV alone (12%) groups (p=0.20).
• Premature rupture of membranes occurred in 15% of women in the amnioinfusion group.

Conclusions:

• Amnioinfusion before a second ECV attempt does not significantly enhance the likelihood of achieving cephalic presentation at delivery.
• The potential benefit of amnioinfusion in this context is not supported by the study findings.
• Increased risk of premature rupture of membranes noted with amnioinfusion.