BACKGROUND: External cephalic version (ECV) is a medical procedure in which an extracorporeal manipulation is performed to render the breech presentation (BP) fetus in the cephalic position. The use of anesthesia to facilitate repositioning has been evaluated in various randomized clinical trials (RCTs), but its potential effectiveness remains controversial.
METHODS: A systematic literature search was carried out in 8 electronic databases. In the meta-analysis, a random effects model was used to calculate the pooled relative risk (RR) and its 95% confidence interval (CI), and the pooled standardized mean difference (SMD) and its 95% CI, in order to systematically assess the effect of anesthesia on the success rates of ECV, vaginal delivery, cesarean delivery as well as other outcomes. Relevant subgroup analyses, publication bias test and sensitivity analyses were also conducted.
RESULTS: This review included 17 RCTs. Women who received anesthesia had a significantly higher incidence of successful ECV (RR: 1.37, 95% CIs: 1.19-1.58) and vaginal delivery (RR: 1.23, 95% CIs: 1.03-1.47), and a significantly lower incidence of cesarean delivery (RR: 0.69, 95% CIs: 0.53-0.91), compared with those who did not.
CONCLUSIONS: The administration of anesthesia not only significantly reduces maternal pain but also significantly increases the success rate of ECV in women with malpresentation at term, leading to a significant rise in the incidence of vaginal delivery. However, it may increase the incidence of maternal hypotension.
BACKGROUND: The protocol was prospectively registered with PROSPERO, registration CRD42022381552.

Objective: To explore the feasibility of using ultrasonic convex array probe compressing abdominal wall to increase success rate of external cephalic version (ECV) without anesthesia in full-term and near-term pregnancy. Methods: Totally 190 singleton and non-cephalic presentation pregnant women in 36-39+4 weeks of gestation performed ECV from April 2019 to August 2023 in the First Affiliated Hospital of Nanjing Medical University were analyzed. According to whether use the ultrasound probe compressing fetal breech or not, the pregnant women were divided into two groups: 81 cases in the probe-compressing group (including primipara 61 cases and multipara 20 cases) and 109 cases in the non-probe-compressing group(including primipara 72 cases and multipara 37 cases). Clinical data, ECV related factors and complications were analyzed and compared between the two groups. Results: (1) The overall success rate of ECV was 64.2% (122/190). There was no significant difference in the success rate of ECV between probe-compressing group and non-probe-compressing group [69.1% (56/81) vs 60.6% (66/109), χ2=1.490, P=0.222]. The total vaginal delivery rate after successful ECV was 81.1% (99/122), while 71.1% (54/76) in primipara and 97.8% (45/46) in multipara, respectively. (2) Compare to the non-probe-compressing group, the success rate of ECV in primipara was significantly higher in the probe-compressing group [45.8% (33/72) vs 70.5% (43/61)], but the gestational age was shorter and the height was higher in the probe-compressing group (all P<0.05). The success rate of ECV of multipara in the probe-compressing group (65.0%, 13/20) was lower than that in the non-probe-compressing group (89.2%, 33/37), but there was no significant difference between the two groups (P>0.05). (3) Multivariate logistic regression analysis showed that abdominal wall compressed by ultrasound probe (OR=2.601, 95%CI: 1.113-6.075; P=0.027) and amniotic fluid index (AFI; OR=1.010, 95%CI: 1.001-1.020; P=0.028) were positive factors for the successful rate of ECV in primipara pregnant women. (4) The main complication of ECV was transient fetal heart rate reduction (8.9%,17/190), the incidence in the probe-compressing group was significantly higher than that in the non-probe-compressing group [14.8% (12/81) vs 4.6% (5/109); χ2=5.967, P=0.015]. No statistical differences were found in rates of complications between the ECV successful and unsuccessful pregnant women, and between probe-compressing and non-probe-compressing groups (all P>0.05). No adverse maternal and neonatal outcomes related to ECV were observed. Conclusions: The ultrasonic convex array probe compressing could significantly improve the success rate of ECV in primipara without increasing the incidence of adverse maternal and fetal outcomes. The success rate of ECV in primipara is influenced by AFI and operation mode.
目的： 探讨腹部超声凸阵探头可视化下加压推离胎臀提高无麻醉下足月及近足月臀位外倒转术（ECV）成功率的可行性。 方法： 收集2019年4月至2023年8月南京医科大学第一附属医院190例妊娠36~39+4周、单胎臀位行ECV孕妇的临床资料，根据是否应用腹部超声凸阵探头可视化下加压（即探头加压法）推离胎臀分为加压组（81例，其中初产妇61例、经产妇20例）及未加压组（109例，其中初产妇72例、经产妇37例）。分析比较加压组与未加压组孕妇的临床特点、ECV成功率、并发症及分娩结局。 结果： （1）总体ECV成功率为64.2%（122/190），其中，加压组与未加压组孕妇的ECV成功率分别为69.1%（56/81）与60.6%（66/109），两组比较，差异无统计学意义（χ2=1.490，P=0.222）。ECV成功后阴道分娩率为81.1%（99/122），其中，经产妇与初产妇的阴道分娩率分别为97.8%（45/46）、71.1%（54/76）。（2）加压组初产妇的ECV成功率高于未加压组初产妇［分别为70.5%（43/61）、45.8%（33/72）］，且加压组初产妇的身高更高、行ECV时孕周更小，分别比较，差异均有统计学意义（P均<0.05）；加压组经产妇的ECV成功率（65.0%，13/20）低于未加压组经产妇（89.2%，33/37），但两组比较，差异无统计学意义（P>0.05）。（3）初产妇ECV成功率的多因素logistic回归分析结果显示，采用探头加压法（OR=2.601，95%CI为1.113~6.075；P=0.027）、羊水指数（OR=1.010，95%CI为1.001~1.020；P=0.028）均是初产妇ECV成功的影响因素。（4）ECV的并发症主要为一过性胎心率减慢（8.9%，17/190），其中，加压组的发生率显著高于未加压组［分别为14.8%（12/81）、4.6%（5/109）；χ2=5.967，P=0.015］。其他并发症在ECV成功与失败孕妇中、加压组与未加压组孕妇中分别比较，差异均无统计学意义（P均>0.05）。所有孕产妇及新生儿未发生与ECV相关的不良母儿结局。 结论： 采用探头加压法可明显提高初产妇的ECV成功率，且不增加母儿不良结局的发生，初产妇ECV成功率受操作方法和羊水量的影响。.

BACKGROUND: Hydatid cystic disease (HCD) is primarily a disease of sheep and cattle. Human beings are accidental hosts. It is prevalent in the Tibet Autonomous Region (TAR) of China. In pregnancy, it can cause many complications.
METHODS: We present a multigravida with breech presentation at 37 weeks of pregnancy in whom a large pelvic hydatid cyst and multiple hepatic hydatids were diagnosed by ultrasonography. The large pelvic hydatid cyst was drained through the posterior fornix under the guidance of ultrasound, and an external cephalic version was performed. A healthy baby was delivered vaginally with head presentation at term.
CONCLUSIONS: HCD during pregnancy presents with management difficulty. It is important to formulate individualized treatment plans according to the actual situation of the patient and the local level of treatment.

To establish a clinical-based nomogram for predicting the success rate of external cephalic version (ECV) through a prospective study. This was a single-center prospective study that collected eligible breech pregnant women. 152 participants were enrolled in the training cohort, who received ECV procedures performed by a single operator. We used the training cohort to establish regression equations and prediction models. These variables include maternal factors (age, operation gestational age, pre-pregnancy BMI (Body Mass Index), operation BMI, BMI increase, multipara), ultrasound factors (fetal weight estimation, amniotic fluid index, placental location, type of breech presentation, spinal position), and anesthesia. Univariate and multivariable analyses were used to screen the factors affecting the success of ECV. A nomogram scoring model was established based on these factors. And C-index, DCA (Decision Curve Analysis) and calibration curve, Hosmer-Lemeshow test was used to verify the prediction effect of the model. Finally, 33 participants were enrolled in the testing cohort who received ECV with an unrestricted operator. We used C-index, DCA (decision curve analysis), and Hosmer-Lemeshow to verify the application value of the prediction model. The calibration curves and ROC curves of both the training cohort and testing cohort are plotted for internal and external validation of the model. The ECV success rate of the training cohort was 62.5%. Univariate analysis showed that the predictors related to the success rate of ECV were age, BMI increase value, AFI (amniotic fluid index), breech type, placental location, spinal position, anesthesia, and multipara. The prediction thresholds of the corresponding indexes were calculated according to the Youden index. Multivariate logistic regression analysis showed that BMI increase ≥ 3.85 kg/m2, AFI ≥ 10.6 cm, anesthesia, multipara, and non-anterior placenta were independent predictors of ECV success. Through the internal and external validation, it is confirmed that the model has a good calibration and prediction ability. Our nomogram has a good ability to predict the success rate of ECV.

OBJECTIVE: To investigate the manipulative reduction in abnormal uterine inclination in vaginal delivery.
METHODS: With the independently developed uterine inclination surveyor, 40 primiparas with abnormal uterine inclination were randomly divided into two groups: treatment group (Group A, 20 cases) and control group (Group B, 20 cases). The general condition of the primipara, the labor stages, the changes in uterine inclination after treatment, postpartum hemorrhage at 2 hours, and the general condition of fetuses were observed to study the therapeutic value of manual reduction in abnormal uterine inclination.
RESULTS: In the control group, one uterine inclination was not corrected with the change in labor process, and the pregnancy was terminated due to stagnation of the active phase. In the first stage of labor, the time spent in the treatment group (393.4 ± 31.3 mins) was significantly lower than that in the control group (440.7 ± 34.9 mins) (P = 0.001). Compared with the control group (49.8 ± 6.5 mins), the treatment group (42.6 ± 7.2 mins) also exhibited a significantly shortened second stage of labor (P = 0.02). Sixteen cases (16/20) in the treatment group returned to normal after manual reduction, and 9 cases (9/20) in the control group returned to normal with the progression of natural labor. Manual reduction could be used as an option to treat abnormal uterine inclination (P = 0.01). There was no significant difference in the third stage of labor (P = 0.2), 2-hour postpartum hemorrhage (P = 0.35), Apgar score (P = 0.64), or body weight (P = 0.76) between the two groups.
CONCLUSIONS: Manual reduction in the treatment of abnormal uterine inclination has obvious effects, shortens the birth process, and is safe for the fetus.

We aimed to examine the prenatal clinical characteristics of women with single pregnancies undergoing external cephalic version (ECV) without anesthesia, develop a novel scoring system for predicting the ECV success rate, and demonstrate that this scoring system can be used to individualize the timing of ECV attempts.
We enrolled 270 women who underwent ECV without anesthesia at 37-40 weeks of gestation in the Fujian Maternity and Child Health Hospital from 2016 to 2019 and divided them into two ECV outcome groups (success vs. failure). We identified five clinical features (the fetal buttocks\' station, the sum of the fundal height and station, the fetal head location, and whether the fetal head or buttocks could be grasped) as independent factors affecting the ECV success rate, and we scored them using a regression coefficient.
Women with scores of 0-3 points had ECV success rates, vaginal delivery rates, and delivery gestational ages at 16.67%, 16.67%, and 38.88 weeks, respectively; those with scores of 4-6 points had ECV success rates, vaginal delivery rates, and delivery gestational ages at 65.75%, 58.90%, and 39.62 weeks, respectively; and those with scores of 7-9 points had ECV success rates, vaginal delivery rates, and delivery gestational ages at 93.71%,74.83%, and 40.00 weeks, respectively.
The ECV success and vaginal delivery rates increased with the score, and the delivery gestational age showed an initial increase. To optimize the ECV procedure and reduce the hospital burden, this scoring system should be used routinely to predict the ECV success rate and determine the timing of ECV attempts.

OBJECTIVE: This study aimed to investigate the success rate, complications, and success-related factors of external cephalic version (ECV) of singleton breech pregnancies after 37 gestational weeks without anesthesia.
METHODS: We studied 40 singleton breech pregnancies in women who underwent ECV without anesthesia after 37 gestational weeks from October 2018 to March 2020. On the basis of success of ECV, the women were divided into two groups of the successful group and the failed group. Various factors were analyzed to determine those that affect the success of ECV.
RESULTS: Of the 40 attempts of ECV, 24 (60.0%) were successful and 16 (40.0%) failed. With regard to success-related factors, parity was significantly different between the two groups, with more multiparous women in the successful group than in the failed group. However, none of the other factors were significantly different between the groups. Fetal outcome was good in all of the cases. Ultimately, 3 cesarean sections were performed in the successful group and 16 were performed in the failed group.
CONCLUSIONS: ECV of breech presentation after the 37th week of pregnancy without anesthesia is an effective and relatively safe alternative, and can effectively reduce the cesarean section rate.

BACKGROUND: The objective of this study is to appraise the efficacy and safety of bupivacaine in pregnant participants with breech presentation (BP) receiving external cephalic version (ECV).
METHODS: The following electronic databases will be searched from the origin to the January 31, 2020: PUBMED, EMBASE, Cochrane Library, CINAHL, ACMD, PsycINFO, Scopus, OpenGrey, and China National Knowledge Infrastructure. No language and publication time limitations will be applied to all of them. Randomized controlled trials comparing bupivacaine to other interventions for pain relief in pregnant participants with BP undergoing ECV will be included in this study. Two authors will employ the selection of searched records, extraction of essential data from included RCTs, and risk of bias assessment for each eligible trail independently and respectively. Any doubts between 2 authors will be figured out by a third author through discussion. The risk of bias assessment will be judged using Cochrane risk of bias tool. The data pooling and analysis will be performed using RevMan 5.3 software.
RESULTS: This study will summarize the up-to-date high-quality evidence and will synthesis the outcome data from that evidence to explore the efficacy and safety of bupivacaine for pain relief in pregnant participants with BP undergoing ECV.
CONCLUSIONS: The findings of this study may present important guidance for patients, clinical practice, as well as health-policy makers regarding the utilization of bupivacaine for pain relief in pregnant participants with BP receiving ECV.
UNASSIGNED: PROSPERO CRD42020164409.

OBJECTIVE: To examine the effects of position management, manual rotation of the fetal position, and using a U-shaped birth stool in primiparous women with a fetus in a persistent occiput posterior position.
METHODS: This was a prospective pilot study of women who delivered at Gansu Provincial Maternity and Child-care Hospital between January and June 2018. The women were divided into the position management ([PM] position management, manual rotation of fetal position, use of a U-shaped birth stool at different stages, and routine nursing) and control groups (position selected by women and routine nursing).
RESULTS: There were 196 women in the PM group and 188 in the control group. There were no significant differences in maternal age, gestational weeks, newborn weight, and the neonatal asphyxia rate between the PM and control groups. The duration of labor was shorter in the PM group than in the control group. Pain and blood loss 2 hours after delivery and the episiotomy rate were significantly lower in the PM group than in the control group.
CONCLUSIONS: Applying position management, manual rotation of the fetal position, and using a U-shaped birth stool should be considered for women with a fetus in a persistent occiput posterior position.

Objective: To investigate the factors associated with the success rate of external cephalic version (ECV) for singleton and non-cephalic presentation pregnancies in the third trimester. Methods: A retrospective study of ECV among singleton and non-cephalic presentation pregnant women in 36-40 weeks of gestation at Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2016 to June 2018 was analyzed. Results: (1) Totally, 251 cases of 358 pregnant women who underwent ECV were successful, with a total success rate of 70.1% (251/358). The success rate of multipara was 79.1% (129/163), while 62.6% (122/195) in primipara (P<0.01). The total vaginal delivery rate was 52.2% (187/358), the vaginal delivery rate of multipara was 61.3% (100/163), while 44.6% (87/195) in primipara (P<0.01). (2) Spontaneous reversion occurred in 7.6%(19/251) of ECV successful women, the rate of reversion of multipara was 10.9% (14/129), higher than that of the primipara [4.1% (5/122); P<0.01]. (3) Among the 232 pregnant women who did not reverted after successful ECV, 187 cases of successful vaginal delivery, the vaginal delivery rate was 80.6% (187/232); the vaginal delivery rate of the multipara was 87.0%(100/115), which was higher than that of the primipara [74.4%(87/117); P<0.01]. (4) The variables significantly associated with ECV success were parity, type of breech, whether fetal presentation was in pelvic or not (all P<0.05). The complication rate was 2.2% (8/358), among which the incidence of fetal distress, placental abruption and transient fetal heart abnormalities were 0.6% (2/358), 0.3% (1/358) and 1.4% (5/358) respectively. Conclusion: By close monitoring, ECV is a safe and effective procedure in selected appropriate cases, and worthy of clinical application.
目的： 探讨足月及近足月非头位行外倒转术（ECV）的成功率及影响ECV成功的因素。 方法： 收集2016年1月至2018年6月在广西壮族自治区妇幼保健院进行ECV的358例妊娠36~40周、单胎、非头位孕妇的临床资料，分析ECV的成功率及其影响因素。 结果： （1）358例孕妇行ECV，其中251例成功，总ECV成功率为70.1%；其中经产妇的ECV成功率为79.1%（129/163），高于初产妇（62.6%，122/195），两者比较，差异有统计学意义（P<0.01）；总自然分娩率为52.2%（187/358）；其中经产妇的自然分娩率为61.3%（100/163），初产妇为44.6%（87/195），两者比较，差异有统计学意义（P<0.05）。（2）行ECV成功的251例孕妇的胎儿中，自行复转为臀位19例，复转率为7.6%；其中经产妇的复转率为10.9%（14/129），高于初产妇（4.1%，5/122），两者比较，差异有统计学意义（P<0.05）。（3）行ECV成功后未复转的232例孕妇中，187例自然分娩，自然分娩率为80.6%；其中经产妇的自然分娩率为87.0%（100/115），高于初产妇（74.4%，87/117），两者比较，差异有统计学意义（P<0.05）。（4）影响ECV成功的单因素分析显示，产次、胎先露的类型、胎先露是否入盆与ECV的成功率相关（P均<0.05）。ECV的总并发症的发生率为2.2%（8/358），其中胎儿窘迫、胎盘早剥和一过性胎心异常的发生率分别为0.6%（2/358）、0.3%（1/358）和1.4%（5/358）。 结论： 选择合适的孕妇，在严密监护下实施ECV是有效的，值得临床推广应用。.