[Fewer caesarean sections for breech presentation following external cephalic version according to a protocol in a special office visit].
OBJECTIVE
Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV--performed according to a standardized protocol in an outpatient clinic--on the mode of delivery.


METHODS
Retrospective analysis.


METHODS
In 2003 a standardized protocol of ECV was developed in the outpatient clinic for obstetrics of the Catharina Hospital in Eindhoven, the Netherlands; it was tested in 'version office visits'. Obstetric characteristics of all pregnant women who underwent attempts of ECV in the clinic from January 2004 until June 2006 during these sessions, and the subsequent births, were analysed. 85% of all ECVs were performed by the same hospital midwife and gynaecologist, in accordance with the protocol.


RESULTS
ECV was successful in 96 of 209 pregnant women (46%). In 1 pregnant woman an emergency caesarean section was performed after ECV because of partial abruptio placentae. Nulliparity, incomplete breech presentation and low birth weight of the baby were associated with a lower success rate of ECV in this study. In the group with a successful ECV the percentage of caesarean deliveries was substantially lower (9 versus 83%; odds ratio: 0.21; 95% CI: 0.09-0.51).


CONCLUSIONS
A regular team consisting of a hospital midwife and a gynaecologist working according to a standardized protocol for ECV in a case of breech presentation proved successful: the number of term breech presentations substantially diminished and therefore the percentage of caesarean sections was lower in the group in which ECV had been successful. This could have considerable impact on health care in the Netherlands in terms of reduced maternal morbidity and cost savings.
Kuppens
S M I
SM
Catharina-ziekenhuis, afd. Obstetrie en Gynaecologie, Eindhoven. simone.kuppens@cze.nl
Hasaart
T H M
TH
van der Donk
M W P
MW
Huibers
M
M
Franssen
M J
MJ
de Becker
B M J
BM
Wijnen
H A A
HA
Pop
V J M
VJ
D000328:Adult; D001946:Breech Presentation / Q000601:surgery / Q000628:therapy*; D002585:Cesarean Section / Q000706:statistics & numerical data; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008880:Midwifery / Q000592:standards; D009426:Netherlands; D009774:Obstetrics / Q000592:standards*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014710:Version, Fetal / Q000379:methods*