PubMed · 11213115
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W C Leung, T C Pun. 2001-01-20. Term breech trial.. https://doi.org/10.1016/s0140-6736(05)71318-0
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OBJECTIVE: To assess UK obstetricians' preferences about mode of delivery for themselves or their partners and determine whether these changed since 1995. STUDY DESIGN: All 313 registered obstetricians in London and one in five (279) sample of those outside London were sent a structured anonymous postal questionnaire. RESULTS: The response rate was 54%. In a hypothetical uncomplicated first singleton pregnancy with a cephalic presentation at term, 15% chose elective caesarean section (CS) (17% in London versus 13% outside London). The overall rate for London has not changed since 1995 (17 versus 17%), although the difference between women and men was less (31 versus 8% in 1995 and 21 versus 14% in 1999, respectively). The number choosing elective CS increased with estimated foetal weight > 4.0kg (40%) and > 4.5kg (65%) and with breech presentation both in a first pregnancy (69%) and after a previous vaginal delivery (49%). CONCLUSION: The overall attitude of London obstetricians to mode of delivery for themselves or their partners has not changed since 1995 and is similar to those of UK obstetricians elsewhere.
OBJECTIVE: To evaluate the effectiveness of an intervention package to promote external cephalic version (ECV). STUDY DESIGN: (1) Design and Setting--A randomised-controlled trial of 20 consultant-based maternity units in the West Midlands NHS Region. (2) Intervention Units--One consultant obstetrician from each unit was encouraged to promote changes in clinical practice within their unit. A multifaceted package including a workshop, written material, guidelines and videos was delivered to these consultants. (3) Control Units--No intervention. (4) Main Outcome Measure--The percentage of women with breech presentation at term who were offered ECV in the antenatal clinic, before and after the intervention. RESULTS: Pre-intervention, there was no difference between the intervention and control units in the proportion of women offered ECV (20 and 19%, respectively). Post-intervention, the proportions were 15% in the control group and 36% in the intervention group (P=0.016). CONCLUSION: This type of intervention package can alter clinical practice and increase the proportion of women with breech presentation at term being offered ECV after the intervention.
The Royal College of Obstetricians and Gynaecologists (RCOG) has recommended that all women with an uncomplicated pregnancy and a breech presentation at term should be offered external cephalic version (ECV) but only 43% of consultants in England practice ECV. There is a need to train clinicians to perform ECV safely and effectively. A model abdomen is described which fulfils these requirements. The model is adjustable to represent a continuum from an easy procedure to an impossible procedure. The model was used to train and assess two midwives in the technique of ECV. This model is a valuable method of both training a clinician to perform ECV and also providing an objective method of assessing their technique. It has the potential to maximise the success rate of the newly trained clinician prior to performing ECV on women.