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At least 37 records · Page 2Linked to original sources
PubMed2000

Effect of external cephalic version at term on fetal circulation.

OBJECTIVE: We sought to investigate the subclinical effect of external cephalic version on fetal circulation. STUDY DESIGN: A prospective observational study was conducted on 136 subjects who had external cephalic version at or beyond 36 weeks of gestation without clinical complication. Doppler ultrasonographic studies of the umbilical and middle cerebral circulations were performed before and after the external cephalic version. The following Doppler indexes were measured: (1) the pulsatility index of the umbilical artery, which represents disturbance of placental circulation, and (2) the pulsatility index of the fetal middle cerebral artery, which represents fetal response. The Wilcoxon signed rank test was used for all statistical analyses. RESULTS: There was no significant difference in pulsatility index of the umbilical artery before and after external cephalic version (P =.674). There was a statistically significant reduction in the pulsatility index of the middle cerebral artery after external cephalic version (P =.043), and this difference existed only among multiparous women (P =.029), among those in whom the external cephalic version was considered to be difficult (P =.038), and when the placenta was posteriorly located (P =.028). The reduction in pulsatility index was not related to whether the external cephalic version was successful. In all cases the Doppler indexes remained within the normal ranges, and there were no associated fetal complications. CONCLUSION: External cephalic version was not associated with any significant disturbance of placental resistance to blood flow. Conversely, external cephalic version was associated with a significant reduction in the pulsatility index of the middle cerebral circulation, especially among the multiparous women, after a difficult procedure or in those with a posterior placenta. This probably represents a normal fetal physiologic response to manipulation of the fetal head.

Bradycardia↗
PubMed2006

Uterine torsion and fetal bradycardia associated with external cephalic version.

BACKGROUND: Torsion of the gravid uterus is a rare obstetric complication in humans, but has been reported in association with malpresentation and with uterine leiomyomata. CASE: We report a case of uterine torsion diagnosed at emergency cesarean delivery after external cephalic version with prolonged fetal bradycardia. CONCLUSION: Physicians should be aware of the possibility of uterine torsion as a complication of external cephalic version. To minimize diagnostic delay, placental localization on ultrasonography should be noted before and after external cephalic version as an indicator of uterine orientation.

Adult↗
PubMed1995

Fetal acoustic stimulation as an adjunct to external cephalic version.

OBJECTIVE: To evaluate fetal acoustic stimulation (FAS) as an adjunct to external cephalic version in a midline fetal spine presentation. STUDY DESIGN: Breech presentation in a woman presenting for attempted version at 37 weeks' gestation with a fetus in a midline position and the spine anterior is difficult to convert to a vertex. An evaluation of FAS to assist in repositioning the fetus in a more spine lateral position was carried out. Patients with a failed version attempt and a midline breech presentation were enrolled in the study. The patient served as her own control. If that attempt failed, an electrolarynx device was used to produce a one- to three-second stimulus, and then another version attempt was made. RESULTS: Sixteen patients were enrolled. Prior to FAS, 0/16 fetuses were successfully turned. FAS altered the position in 100% of patients from spine midline to lateral. After FAS, 15/16 (94%) were successfully converted to vertex presentation. The one patient whose fetus failed to convert also failed her second version attempt (P < .0005). CONCLUSION: FAS may improve the opportunity for successful external cephalic version in the properly selected candidate with a fetus in a midline position with the spine anterior.

Acoustic Stimulation↗
PubMedDate not supplied

Fetal complication after external cephalic version at term: case report and literature review.

We report a case of fetal distress following external cephalic version at term, which resulted in delivery by emergency cesarean section of an anemic, acidemic infant. The characteristics of the fetal heart rate tracing, the clinical findings, and a positive Kleihauer-Betke test after delivery suggest that fetomaternal hemorrhage or placental abruption was the most likely cause of the fetal distress. We review the incidence of the reported fetal complications after external version.

Acidosis↗
PubMed1990

Development and application of a simple expert system for the interpretation of the antepartum fetal heart rate tracings (version 88/2.29).

A simple expert system is developed for the interpretation of antepartum fetal heart rate tracings. The perinatal expert chose to use the phrase 'Fetal Reserve' to describe what the cardiotocogram is indirectly measuring. Our analysis program gives numerical values to each CTG such as 5, 4, 3, 2.5, 2 and 1 corresponding to the fetal reserve conditions of good, satisfactory, probably satisfactory with uncertainty, borderline, decreased, and critical respectively. This study consists of 33 normal pregnancies with normal outcome. Each patient is followed by our computerized system biweekly from the 28th to the 38th gestational week and weekly there after. The expert system's decision for 28th, 30th, 32nd, 34th, 36th, 38th, 39th and 40th gestational weeks were 3.3 +/- 1.0, 3.8 +/- 0.7, 3.8 +/- 1.0, 4.1 +/- 0.9, 4.1 +/- 0.7, 3.6 +/- 1.0, 4.2 +/- 1.0, 3.8 +/- 0.9 and 3.4 +/- 1.2, respectively. In this study, we have used confusion matrix to determine the normal, security, and danger zones according to the perinatal expert and the expert system and the discriminatory power of the system is found to be highly significant statistically (Q = 221). We also showed that the passive test (non-stress test) in normal pregnancies has demonstrated false positive results in 4.2 and 9.3% of the cases according to the evaluations of the perinatal expert and the expert system, respectively.

Expert Systems↗
PubMed1991

The validation of a computerized system for the interpretation of the antepartum fetal heart rate tracings (version 89/2.34).

We have developed a knowledge-based system for the interpretation of the antepartum fetal heart rate tracings. This study consists of four groups of patient: (1) 49 normal pregnancies with a normal perinatal outcome; (2) 13 normal pregnancies with abnormal perinatal outcome; (3) 33 high-risk pregnancies with abnormal perinatal outcome; and (4) 16 high-risk pregnancies with normal perinatal outcome. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of our expert system (version 89/2.34) were estimated to be 60.0, 85.7, 75.0 and 75.0%, respectively. When the normal pregnancies with abnormal outcome and the high-risk pregnancies with normal outcome were excluded from the population, sensitivity, specificity, PPV and NPV were calculated to be 57.7, 82.9, 68.2 and 75.6%, respectively (corrected values). The prevalance of abnormal outcome for this study was 41.7%.

Cardiotocography↗
PubMed2004

[Alternative methods instead of external cephalic version in the event of breech presentation. Review of the literature].

Fetal breech presentation at term is more and more treated by a planned cesarean section. Considering the increased maternal morbidity and mortality in relation to abdominal delivery versus vaginal birth, natural and innocuous methods have been proposed for the promotion of a spontaneous fetal cephalic version during the last two Months of pregnancy. In order to stimulate fetal motility many techniques have been described, either advising postural methods (passive bridge, Indian version, knee-chest position) or using acupuncture (stimulation of the fifth toe and auricular points). Other techniques like chiropractic manipulations or hypnosis have also been tried. Unfortunately, most publications are retrospective and methodologically inaccurate, but it seems that their results may be favorably compared with that of the external cephalic version, a much more complex procedure, which is potentially dangerous and certainly time consuming and expensive. The only randomized controlled trial with a proven efficacy concerns moxibustion (burning herbs to stimulate the acupoint BL 67 or Zhiyin, located beside the outer corner of the fifth toenail).

Acupuncture Therapy↗
PubMed1996

Computerized analysis of fetal heart rate changes after antepartum external cephalic version.

OBJECTIVE: To assess the fetal heart rate (FHR) changes following external cephalic version using a computerized FHR monitor. STUDY DESIGN: We performed 116 external cephalic versions on 106 pregnant women at 36-40 weeks' gestation. Tocolysis (magnesium sulfate) was given to 39 patients (34%). Computerized FHR monitoring was performed for 20-30 minutes before and for 20-30 minutes after the procedure. In addition, we analyzed the results of the FHR tracing obtained during the first 10 minutes following the procedure. RESULTS: External cephalic version was successful in 40% of the patients. In the group of patients who were not treated with magnesium sulfate, FHR variation and the number of accelerations per 10 minutes were significantly reduced during the first 10 minutes following the procedure as compared with those factors on the FHR tracings obtained before or 20-30 minutes following the procedure (P < .05). In the group of patients who were treated with magnesium sulfate, FHR variation and the number of accelerations per 10 minutes were significantly reduced before and 10 minutes after the procedure as compared with the FHR tracings obtained 20-30 minutes following the procedure (P < .05). In both groups the basal FHR was significantly lower during the first 20-30 minutes following the procedure (P < .05). FHR decelerations were observed following the procedure in only two patients. None of the 106 fetuses had a low Apgar score or were admitted to the neonatal intensive care unit. CONCLUSION: External cephalic version appears to be safe for the mother and fetus, although transient FHR changes may occur following the procedure.

Adult↗
PubMed1992

External cephalic version and daily post-versional maternal self-assessment of fetal presentation. A prospective study.

External cephalic version (ECV) using tocolysis is a widely recognized low-risk intervention in cases of breech presentation, particularly in areas where resources are scarce and the perinatal mortality is high in vaginal breech deliveries. In such a setting, pregnant women were trained to make regular self-assessments of the presenting fetal part after ECV in order to detect spontaneous reversions to breech presentation. It was found that such maternal involvement could significantly improve the final results of ECV.

Breech Presentation↗
PubMed2004

Fetal femur fracture and external cephalic version.

BACKGROUND: Femoral fractures due to birth trauma are extremely rare. External cephalic version is considered a relatively safe alternative when dealing with breech presentation, but it can be associated with complications. CASE: This patient underwent elective cephalic version for breech presentation at 36 weeks of gestation. Due to concerns of fetal distress after the version, a cesarean delivery was performed. The newborn had a bruised leg at delivery, and X-ray studies confirmed a distal femoral corner fracture. CONCLUSION: This case demonstrates another risk of external cephalic version. Physicians and patients should be aware of this potential complication.

Adult↗
PubMed2000

Outcome of labour after successful external cephalic version at term complicated by isolated transient fetal bradycardia.

OBJECTIVES: To investigate factors associated with the occurrence of transient fetal bradycardia after external cephalic version, and labour outcome after isolated transient fetal bradycardia. DESIGN: Cohort study. SETTING: Teaching hospital with a policy of offering external cephalic version for breech presentation at or beyond 36 weeks of gestation. POPULATION: Four hundred and twenty-nine external cephalic versions performed over a 5-year period. METHODS: Between group differences were compared with the unpaired t test or the chi2 test. Logistic regression analysis was performed to exclude confounding effects. MAIN OUTCOME MEASURES: Incidence of caesarean section for fetal distress. RESULTS: Transient fetal bradycardia occurred in 8.4% of external cephalic versions, and was associated with a successful version (OR 16.45, P < 0.001), a difficult procedure (OR 3.70, P = 0.001), and nulliparity (OR 2.83, P = 0.007). The incidence of intrapartum caesarean section for fetal distress was 16.7% in pregnancies with transient fetal bradycardia, compared with 7.9% in those without (OR 2.34, 95% CI 0.81, 6.71). CONCLUSIONS: Transient fetal bradycardia after external cephalic version may be associated with a higher risk of intrapartum caesarean section for fetal distress.

Bradycardia↗
PubMedDate not supplied

Clinical implications from an exploratory study of postural management of breech presentation.

The results from an exploratory study of the effectiveness of maternal knee-chest posture for producing cephalic version of breech presentation are shown. Methods are briefly described and clinical implications are presented. Among 25 women, fewer who performed the maternal knee-chest postural intervention experienced fetal cephalic version than women in the control group who did nothing to influence breech presentation. Despite limitations of the underpowered findings, trends in the data may indicate that parity and gestational age were potentially relevant covariates of version. Postural management is not an evidence-based practice. This exploratory study indicates that maternal knee-chest posture may work opposite to the expected direction, but the small sample size precludes generalizations about efficacy of knee-chest postural management. At least one adequately powered trial that controls for parity and gestational age is needed to determine whether knee-chest postural management results in no effect, a small, or small to moderate clinically significant effect.

Apgar Score↗
PubMed1987

Fetal heart rate changes following external cephalic version under tocolysis near term.

Fifty eight gravidas near-term underwent external cephalic version using tocolytic treatment and continuous fetal monitoring by cardiotocograph and real-time ultrasound. No unfavorable maternal or fetal effects were recorded. Fetal heart rates showed a significant decline at 10 and 30 min after the procedure with complete recovery at 1 h after external version, but no pathologic tracing was recorded. No uniform heart rate patterns due to external cephalic version could be found.

Breech Presentation↗
PubMed1995

Fetal acoustic stimulation, an adjunct to external cephalic version: a blinded, randomized crossover study.

OBJECTIVE: Our purpose was to determine whether fetal acoustic stimulation can improve the chance of successful external cephalic version in patients at 36 to 38 weeks' gestation with fetal midline spine position. STUDY DESIGN: A randomized, blinded crossover trial was performed. In this "N of 1" study, the patient served as her own control. RESULTS: Twenty-six patients were enrolled in the study, and three were excluded due to engagement of the fetal breech. In the initial trial with fetal acoustic stimulation to the maternal abdomen, 12 of 12 (100%) changed position to spine lateral and 11 of 12 (92%) were successfully verted. In the control group (fetal acoustic stimulation to nurse's arm), none of 11 (0%) changed position to spine lateral and one of 11 (9%) were successfully verted (p < 0.0001). In the crossover trial eight of 10 (80%) of the original placebo (control) patients were successfully verted after fetal acoustic stimulation to the maternal abdomen and none of 1 (0%) from the original treatment group were successfully verted after placebo fetal acoustic stimulation (p < 0.0001). Combined data from the original and crossover trials indicates 19 of 22 (86%) successful versions after fetal acoustic stimulation to maternal abdomen compared with one of 12 (8%) that had successful external cephalic version after placebo fetal acoustic stimulation. CONCLUSION: Fetal acoustic stimulation shifts fetal position to spine lateral, which increases successful version of fetuses with midline fetal spine presentations.

Acoustic Stimulation↗