title: A retrospective study of the success, safety and effectiveness of external cephalic version without tocolysis in a specialised midwifery centre in the Netherlands.
abstract: BACKGROUND
  to evaluate the effectiveness of external cephalic version (ECV) without tocolysis or epidural analgesia, the complications associated with the procedure and the association between the number of ECV attempts and cephalic presentation at birth and caesarean section.
  
  
  METHODS
  retrospective cohort study of all (n=924) ECVs carried out between 1996 and 2000 in a specialised midwifery centre in the Netherlands. After bivariate analysis, those variables with a p value under 0.05 were considered statistically significant and were tested in a logistic regression model using backward stepwise selection. Analyses were carried out separately for first ECV attempts and second ECV attempts.
  
  
  RESULTS
  in total, 958 ECVs were analysed, 889 first attempts and 69 repeat attempts. Seventy per cent of all first ECVs were carried out before 37 weeks, but half of those were carried out between 36 and 37 weeks. The success rate for first ECV was 41% and for the second ECV 29%. Bivariate analysis showed that the success of the first ECV was positively influenced by parity, non-Dutch origin, higher birth weight, higher age and longer duration of pregnancy. After logistic regression, parity (odds ratio [OR] 2.8, 95% CI 2.1 to 3.7), non-Dutch origin (OR 1.8, 95% CI 1.2 to 2.8) and birth weight (OR 1.7, 95% CI 1.4 to 2.0) remained factors that independently influenced the success of ECV. The odds ratio for duration of pregnancy at first ECV was borderline significant: OR 1.2 (1.0 to 1.4). After an unsuccessful first ECV, only 13% of the women received a second ECV. The prevalence of cephalic presentation at birth increased with 3% after a second ECV. Three cases of complications were reported during or very shortly after the first ECV, and these did not result in serious complications. No complications were reported after a second ECV.
  
  
  CONCLUSIONS
  ECV without tocolysis is a safe procedure for pregnant women and their babies. Repeat ECV increases the number of cephalic presentations at birth and should be considered after an unsuccessful ECV.
authors.affiliation: TNO Quality of Life, Prevention and Physical Activity, Child Health Division, P.O. Box 2215, 2301 CE Leiden, The Netherlands. marlies.rijnders@tno.nl
authors.forename: Marlies
authors.initials: M
authors.lastname: Rijnders
authors.forename: Kathy
authors.initials: K
authors.lastname: Herschderfer
authors.forename: Marianne
authors.initials: M
authors.lastname: Prins
authors.forename: Riet
authors.initials: R
authors.lastname: van Baaren
authors.forename: Anne-Johan
authors.initials: AJ
authors.lastname: van Veelen
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schönbeck
authors.forename: Simone
authors.initials: S
authors.lastname: Buitendijk
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000451:nursing; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000458:organization & administration*; D009426:Netherlands / Q000453:epidemiology; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D015145:Tocolysis; D014710:Version, Fetal / Q000451:nursing* / Q000706:statistics & numerical data