Introducing external cephalic version in a Malaysian setting.
OBJECTIVE
To assess the outcome of external cephalic version for routine management of malpresenting foetuses at term.


METHODS
Prospective observational study.


METHODS
Tertiary teaching hospital, Malaysia.


METHODS
From September 2003 to June 2004, a study involving 41 pregnant women with malpresentation at term was undertaken. An external cephalic version protocol was implemented. Data were collected for identifying characteristics associated with success or failure of external cephalic version.


METHODS
Maternal and foetal outcome measures including success rate of external cephalic version, maternal and foetal complications, and characteristics associated with success or failure; engagement of presenting part, placental location, direction of version, attempts at version, use of intravenous tocolytic agent, eventual mode of delivery, Apgar scores, birth weights, and maternal satisfaction with the procedure.


RESULTS
Data were available for 38 women. External cephalic version was successful in 63% of patients; the majority (75%) of whom achieved a vaginal delivery. Multiparity (odds ratio=34.0; 95% confidence interval, 0.67-1730) and high amniotic fluid index (4.9; 1.3-18.2) were associated with successful external cephalic version. Engagement of presenting part (odds ratio=0.0001; 95% confidence interval, 0.00001-0.001) and a need to resort to backward somersault (0.02; 0.00001-0.916) were associated with poor success rates. Emergency caesarean section rate for foetal distress directly resulting from external cephalic version was 8%, but there was no perinatal or maternal adverse outcome. The majority (74%) of women were satisfied with external cephalic version.


CONCLUSIONS
External cephalic version has acceptable success rates. Multiparity, liquor volume, engagement of presenting part, and the need for backward somersault were strong predictors of outcome. External cephalic version is relatively safe, simple to learn and perform, and associated with maternal satisfaction. Modern obstetric units should routinely offer the procedure.
Yong
Stephen P Y
SP
Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong. drpyyong@hotmail.com
D000328:Adult; D000653:Amniotic Fluid; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007746:Labor Presentation; D008296:Malaysia; D010298:Parity; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D015149:Tocolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D014710:Version, Fetal
D015149:Tocolytic Agents