title: External cephalic version in premature rupture of membranes: a systematic review.
abstract: BACKGROUND
  External cephalic version (ECV) increases the likelihood of a vaginal delivery in patients with breech presentation. Our objective was to determine the rate of cephalic vaginal delivery in women undergoing ECV after PROM.
  
  
  METHODS
  We performed a systematic review of all case reports, case series and clinical trials of patients undergoing an ECV after PROM ≥ 24 weeks. Maternal demographics and outcome data were obtained. The primary outcome was rate of cephalic vaginal delivery. Statistical analysis was performed for continuous outcomes by calculating mean and standard deviations for appropriate variables.
  
  
  RESULTS
  The systematic review yielded six papers with 13 case reports and no clinical trials of ECV after PROM. The rate of success to cephalic presentation was 46.1% (six of 13 cases), with a subsequent vaginal delivery rate of 23.1% (three of 13 cases). The rate of umbilical cord prolapse was 33.3% (two of six cases).
  
  
  CONCLUSIONS
  ECV after PROM has been reported in 13 cases in the literature. For the cases reported, 46.1% of ECV were successful in turning to cephalic position, but only 23.1% resulted in a vaginal delivery. There was a 33.3% incidence of umbilical cord prolapse. Given the high rate of umbilical cord prolapse, it would be imperative to offer an ECV in the setting of PROM only at an institution that has the ability to perform the indicated emergent cesarean delivery and only after appropriate counseling.
authors.affiliation: a Department of Obstetrics and Gynecology , Sidney Kimmel College of Medicine at Thomas Jefferson University , Philadelphia , PA , USA.
authors.forename: Johanna
authors.initials: J
authors.lastname: Quist-Nelson
authors.affiliation: b Sidney Kimmel College of Medicine at Thomas Jefferson University , Philadelphia , PA , USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Landers
authors.affiliation: a Department of Obstetrics and Gynecology , Sidney Kimmel College of Medicine at Thomas Jefferson University , Philadelphia , PA , USA.
authors.forename: Rebekah
authors.initials: R
authors.lastname: McCurdy
authors.affiliation: a Department of Obstetrics and Gynecology , Sidney Kimmel College of Medicine at Thomas Jefferson University , Philadelphia , PA , USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D001946:Breech Presentation / Q000628:therapy*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D014710:Version, Fetal / Q000379:methods*
keywords: External cephalic version; premature rupture of membranes; rupture of membranes; vaginal delivery