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: Malposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland\'s) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies.
OBJECTIVE: To gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods.
METHODS: A survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis.
RESULTS: 252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland\'s rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior.
CONCLUSIONS: There is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.

External cephalic version is a procedure used to turn a fetus from a breech position to a cephalic position before delivery. The success rate of the external cephalic version can be affected by various factors; however, the effect of bladder volume on the success rate of the external cephalic version remains controversial.
This study aimed to determine the effect of urinary bladder status (full or empty) on the success rate of the external cephalic version through a prospective randomized study.
This was a prospective randomized controlled trial conducted at a tertiary care obstetrical center. Overall, 70 women with a singleton breech presentation at term undergoing external cephalic version were randomly allocated into 2 groups: external cephalic version with an empty bladder and external cephalic version with a full bladder. The external cephalic version procedure was performed by experienced obstetricians under ultrasound guidance. The primary outcome was the success rate of the external cephalic version.
The success rate of the external cephalic version was 67.56% (25/37) in the full bladder group and 54.54% (18/33) in the empty bladder group, with no statistically significant difference between the groups (P=.26). In addition, the relative risk of successful external cephalic version was 1.23 (95% confidence interval, 0.84-1.81), indicating no significant difference.
This randomized controlled trial demonstrated that the presence of a full or empty urinary bladder does not significantly affect the success rate of the external cephalic version in women with singleton breech presentation at term. Our findings suggest that women undergoing an external cephalic version do not need to have a full bladder to improve the success rate of the procedure.

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To review the decision aids currently available or being developed to predict a patient\'s odds that their external cephalic version (ECV) will be successful.
We searched PubMed/MEDLINE, Cochrane Central, and ClinicalTrials.gov from 2015 to 2022. Articles from a pre-2015 systematic review were also included. We selected English-language articles describing or evaluating models (prediction rules) designed to predict an outcome of ECV for an individual patient. Acceptable model outcomes included cephalic presentation after the ECV attempt and whether the ECV ultimately resulted in a vaginal delivery. Two authors independently performed article selection following PRISMA 2020 guidelines. Since 2015, 380 unique records underwent title and abstract screening, and 49 reports underwent full-text review. Ultimately, 17 new articles and 8 from the prior review were included. Of the 25 articles, 22 proposed one to two models each for a total of 25 models, while the remaining 3 articles validated prior models without proposing new ones.
Of the 17 new articles, 10 were low, 6 moderate, and 1 high risk of bias. Almost all articles were from Europe (11/25) or Asia (10/25); only one study in the last 20 years was from the United States. The models found had diverse presentations including score charts, decision trees (flowcharts), and equations. The majority (13/25) had no form of validation and only 5/25 reached external validation. Only the Newman-Peacock model (United States, 1993) was repeatedly externally validated (Pakistan, 2012 and Portugal, 2018). Most models (14/25) were published in the last 5 years. In general, newer models were designed more robustly, used larger sample sizes, and were more mathematically rigorous. Thus, although they await further validation, there is great potential for these models to be more predictive than the Newman-Peacock model.
Only the Newman-Peacock model is ready for regular clinical use. Many newer models are promising but require further validation.
· 25 ECV prediction models have been published; 14 were in the last 5 years.. · The Newman-Peacock model is currently the only one with sufficient validation for clinical use.. · Many newer models appear to perform better but await further validation..

The purpose of this study was to examine the efficacy of remifentanil on external cephalic version (ECV) in breech presentation. An extensive search was conducted using PubMed, Cochrane Library, and other grey literature. Only randomized controlled trials using remifentanil for ECV were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes and quality of evidence was assessed using the Risk of Bias and GRADE system. Five studies consisting of 602 patients were analyzed. Remifentanil resulted in a moderate increase in ECV success rate (RR, 1.19; 95% CI, 1.00 to 1.43; P = .05), a large reduction of pain score (MD, -2.02; 95% CI, -2.32 to -1.72; P < .00001) with fewer transient fetal bradycardia (RR, 0.40; 95% CI, 0.19 to 0.85; P = .02). However, remifentanil did not affect cesarean section rates, (RR, 0.97; 95% CI, 0.49 to 1.93; P = .93) instrumental delivery (RR, 0.94; 95% CI, 0.41 to 2.15; P = 0.89), and spontaneous delivery rate (RR, 1.02; 95% CI, 0.78 to 1.35; P = 0.87). Mothers treated with remifentanil have a higher patient satisfaction score. The use of remifentanil may be a good strategy for ECV. However, extrapolation of this finding to clinical settings must consider the study limitations.

OBJECTIVE: Uterine anomalies (UA) occur in up to 6.7% of women. Breech is eight times more likely to occur with UA which may not be diagnosed prior to pregnancy and may only be found in the third trimester with breech. The objective of the study is to assess the prevalence of both already known and newly sonographically diagnosed UA in breech from 36 weeks of gestation and its impact on external cephalic version (ECV), delivery options and perinatal outcomes.
METHODS: We recruited 469 women with breech at 36 weeks of gestation over a 2-year period at the Charité University Hospital, Berlin. Ultrasound examination was performed to rule out UA. Patients with known and newly \'de novo\' diagnosed anomalies were identified and delivery options and perinatal outcomes analyzed.
RESULTS: The \'de novo\' diagnosis of UA at 36-37 weeks of pregnancy with breech was found to be significantly higher compared to the diagnosis prior to pregnancy with 4.5% vs 1.5% (p < 0.001 and odds ratio 4 with 95% confidence interval 2.12-7.69). Anomalies found included 53.6% bicornis unicollis, 39.3% subseptus, 3.6% unicornis and 3.6% didelphys. A trial of vaginal breech delivery was successful in 55.5% of cases when attempted. There were no successful ECVs.
CONCLUSIONS: Breech is a marker for uterine malformation. Diagnosis of UA with breech can be up to four times improved with focused ultrasound screening in pregnancy even from 36 weeks of gestation prior to ECV to identify missed anomalies. Timely diagnosis aids antenatal care and delivery planning. Importantly, definitive diagnosis and treatment can be planned postpartum to improve outcomes in future pregnancies. ECV plays a limited role in selected cases.

We report a novel application of intrapartum sonography, herein used to assist the internal podalic version and the vaginal delivery of a transverse-lying second twin. Following the vaginal delivery of the first cephalic twin, the internal podalic version was performed under continuous ultrasound vision, leading to the uncomplicated breech delivery of a healthy neonate.

暂无摘要。