Is Fear of External Cephalic Version Well-founded?

Česká verzia

Authors: J. Nagy; E. Nyklová
Authors place of work: Nemocnice Milosrdných bratří, Brno, přednosta prim MUDr. I. Huvar, CSc.
Published in the journal: Ceska Gynekol 2008; 73(4): 254-260

Summary

Background and objective:
External cephalic version (ECV) is often denied due to fear of complications and pain during this procedure. The aim of this study was to assess maternal pain perception during ECV and to report the incidence of complications associated with this procedure.

Design:
Prospective study.

Setting:
Hospital of Merciful Brothers, Brno.

Methods:
Study included 110 women undergoing ECV. Pain was measured by visual analog scale (VAS) and descriptive part of Czech version of McGill Pain Questionnaire (MPQ). The overall pain rating index (PRI) and PRI of sensoric (S), affective (A), evaluating (E) and miscellaneuos (M) descriptors of pain was assesed. The assesment was performed in all patient and group of successful and failed ECV was compared by t-test. All complications during ECV were recorded. Incidence of operative deliveries after successful ECV was compared with control group included parturients with cephalic presentantion by odds ratio (OR) with 95% confidence interval (95%CI).

Results:
Forty two ECV (38%) was successful. Mean value of VAS was 4,9, PRI 14,4 (SD=1,9). PRI of particular qualities of pain: S= 8,0, A =1,9, E =2,6, M =2,1. The significant diference between successful and failed ECV group was in VAS (4,2 vs 5,4, p = 0,001) , PRI -A (1,3 vs 2,2, p = 0,018) and PRI-M (1,5 vs 2,5, p = 0,015). We recorded 2 (1,8%) cases of transient fetal bradycardia, 8 ECV (7%) was discontinued for pain and in 52% women after ECV transient decrease in fetal heart rate variability occured. No serious complication was recorded. The incidence of caesarean section after successful ECV was 21% and in control group 16% (OR 1,4 95%CI 0,62;3,01). Incidence of instrumental delivery after ECV was 12%, in control group 5% (OR 2,7 95%CI 0,93; 7,27).

Conclusion:
The pain during ECV was mild and well tolareted. The incidence of complications was small and the most of them were not serious. In this study no reasons for denying ECV were found.

Key word:
breech presentation, external cephalic version, complications, pain measurement.

Zdroje

1. Belg, D., Kunze, U. Critical remarks on external cephalic version under tocolysis. Report on a case of antepartum fetal death. J Perinat Med, 1977, 5, 1, p. 32-38.

2. Brost, BC., Calhoun, BC., Van Dorsten, JP. Compound presentation resulting from the forward-roll technique of external cephalic version: a possible mechanism. Am J Obstet Gynecol, 1996,174, 3, p. 884-885.

3. Collaris, JR.,Guid Oei, S. External cephalic version : a safe procedure? Systematic review of version-related risks. Acta Obstet Gynecol Scand, 2004, 83, p. 511-518.

4. Collins, S., Ellaway, P., Harington, D., et al. The complications of external cephalic version: results from 805 consecutive attempts. Br J Obstet Gynaecol, 2007, 114, 5, p. 636-638.

5. Fok, WY., Chan, LW., Leung, TY., et al. Maternal experience of pain during external cephalic version at term. Acta Obstet Gynecol Scand, 2005, 84, p. 748-751.

6. Gjode, P., Rasmussen, TB., Jorgensen, J. Fetomaternal bleeding during attempts at external version. Br J Obstet Gynaecol, 1980, 87, p. 571-573.

7. Hofmeyr, J., Sonnendecker, EW. Cardiotocographic changes after external cephalic version. Br J Obstet Gynaecol, 1983, 90, 10, p. 914-918.

8. Hofmeyr, GJ., Gyte, G. Intervention to help external cephalic version for breech presentatnion at term (Review). The Cochrane Liberary, 2007, Issue 3.

9. Chan, LY., Leung, TY., Fok, WY., et al. High incidence of obstetric interventions after succesful external cephalic version. Br J Obstet Gynaecol, 2002,109, p. 627-631.

10. Chan, LY., Lau, KT., Chiu, PY., et al. Levels of cord blood thyreoid stimulating hormone after external cephalic version. Br J Obstet Gynaecol, 2001, 108, p. 1076-1080.

11. Impey, L., Pandit, M. Tocolysis for repeat external cephalic version in breech presentationat term: a randomised, double-blind, placebo-controlled trial. Br J Obstet Gynaecol: Internat J Obstet Gyn, 2005, 112, p. 627-631.

12. Lau, TK., Lo, KW., Lueng, TY., et al. Outcome of labour after succesful external cephalic version at term complicated by isolated transient fetal bradycardia. Br J Obstet Gynaecol, 2000, 107, 3, p. 401-405.

13. Lau, TK., Stock, A., Rogers, M. Fetomaternal haemorrhage after external cephalic version at term. Aust N Z J Obstet Gynaecol, 1995, 35, 2, p. 173-174.

14. Leung, TY., Sahota, DS., Fok, WY., et al. Quantification of contact surface pressure exerted during external cephalic version. Act Obstet Gynecol Scand, 2003, 82, p. 1017-1022.

15. Leung, TY., Sahota, DS., Fok, WY., et al. External cephalic version induced fetal cerebral and umbilical flow changes are related to amount o pressure exerted. Br J Obstet Gynaecol, 200, 111, p. 430-435.

16. Melzack, R. The McGill pain questionaire: major properties and scoring methods . Pain, 1975, 1, p. 277-299.

17. Melzack, R. Pain measurement and assessment. New York: Raven press, 1983.

18. Nassar, N., Roberts, CL., Barratt, A., et al. Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term. Paed Perinat Epidemiol, 2006, 20, p. 163-171.

19. Nord, E., Blaschke, E., Green, K., Thornassen, P. 100 cases of external cephalic version with special reference to fetomaternal transfusion. Act Obstet Gynecol Scand, 1989, 568, p. 55-58.

20. Penn, Z. Breech presentation . In James, DK., et al. High risk pregnancy: management options 3rd ed., Philadelphia: Elsevier Saunders, 2006, 1342 p.

21. Petrikovsky, BM., DeSilva, HN., Fumia, FD. Erb@s palsy and fetal bruising after external cephalic version. Am J Obstet Gynecol, 1987, 152, p. 258.

22. Phelan, JP., Stine, LE., Mueller, E., et al. Observations of fetal heart rate characteristids related to external cephalic version and tocolysis. Am J Obstet Gynecol, 1984, 149, 6, p. 658-661.

23. Ranney, B. The gentle art of external cephalic version. Am J Obset Gynecol, 1973, 116, p 239-251.

24. Regalia, AL., Curiel, P., Natale, N., et al. Routine use of external cephalic version in three hospital. Birth, 2000, 27, 1, p. 19-24.

25. Salani, R., Theiler, RN., Lindsay, M. Uterine torsion and fetal bradycardia associated with external cephalic version. Obstet Gynecol, 2006, 108, p. 820-823.

26. Shankar, M., Gough, GW., Chakravarti, S., et al. Massive feto-maternal haemorrhage with good perinatal outcome following failed external cephalic version. Fetal Diagn Ther, 2004, 19, 1, p. 68.

27. Unzeitig, V., Binder, T. Doporučený postup při vedení prenatální péče a porodu donošeného plodu v poloze koncem pánevním. Čes Gynek, 2005, 70, s. 462.

28. Wrigley, AJ. Criticism of ante-natal work. Br Med J, 1934, 1, p. 891-894.

29. Zhang, J., Bowes, WA., Fortney, JA. Eficacy of external cephalic version, including safety, cost-benefit analysis, and impact on cesarean delivery rate. Obset Gynecol, 1993, 82, p. 306 –312.