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External Cephalic Version: Is it an Effective and Safe Procedure?

External Cephalic Version: Is it an Effective and Safe Procedure?

Published on: June 6, 2020

Internal Version Compared With Pushing for Delivery of Cephalic Second Twins.

Victoire Pauphilet¹, François Goffinet, Aurélien Seco

¹Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Université de Paris, INSERM, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Assistance Publique-Hôpitaux de Paris, Maternité Port-Royal, DHU risques et grossesse, Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint-Joseph, and Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique, Paris, Université Paris Sud, Le Kremlin Bicêtre, CHRU de Lille, Maternité Jeanne de Flandre, and Université de Lille 2, Lille, Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Gynécologie Obstétrique, and Université Pierre et Marie Curie, Paris, Centre Hospitalier Intercommunal de Poissy, Service de Gynécologie Obstétrique, Poissy, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, CHU de Strasbourg, Hôpital Hautepierre, and Université de Strasbourg, Strasbourg, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Gynécologie Obstétrique, Le Kremlin Bicêtre, CHU de Bordeaux, Service de Gynécologie Obstétrique, and Université de Bordeaux, Bordeaux, CHU de Toulouse, Service de Gynécologie Obstétrique, and Université Toulouse III Paul Sabatier, Toulouse, and CHU de Nantes, Service de Gynécologie Obstétrique, CIC Mère enfant, INRA, UMR 1280 Physiologie des adaptations nutritionnelles, and Université de Nantes, Nantes, France.

Obstetrics and Gynecology

|May 28, 2020

Summary

Internal version for second twins did not improve neonatal outcomes compared to pushing. While it shortened delivery intervals and reduced C-sections, it did not lower morbidity or mortality, especially before 37 weeks gestation.

Area of Science:

Obstetrics and Gynecology
Neonatal Medicine
Perinatal Research

Background:

Second twins often present challenges for vaginal delivery.
Internal version is an obstetric maneuver to convert a breech second twin to cephalic presentation.
The optimal delivery method for second twins requires careful consideration of neonatal outcomes.

Purpose of the Study:

To compare neonatal morbidity and mortality in cephalic second twins delivered via internal version and breech extraction versus those delivered via pushing.
To evaluate the impact of internal version on intertwin delivery intervals and cesarean delivery rates for the second twin.

Main Methods:

Analysis of the JUMODA cohort, a national prospective study of twin deliveries (n=2,256).
Comparison of internal version (breech extraction) with pushing (cephalic presentation) for second twins born at or after 32 weeks gestation.
Multivariate modified Poisson regression used to assess composite neonatal morbidity and mortality, controlling for confounders.

Main Results:

Internal version was associated with shorter intertwin delivery intervals (5 vs 8 minutes) and lower cesarean rates for the second twin (1.0% vs 3.7%).
Composite neonatal morbidity and mortality was not significantly lower in the internal version group (3.5% vs 2.1%).
Higher neonatal morbidity and mortality was observed in the internal version group before 37 weeks gestation (6.5% vs 3.1%).

Conclusions:

Internal version followed by breech extraction for cephalic second twins was not associated with improved neonatal outcomes compared to pushing.
The findings suggest that internal version may increase neonatal risk, particularly in preterm deliveries.
Further research is needed to confirm these findings and inform clinical practice regarding the management of second twins.

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