Podcast
Questions and Answers
What is a potential risk factor for dystocia after a successful external cephalic version (ECV)?
What is a potential risk factor for dystocia after a successful external cephalic version (ECV)?
How do the rates of cesarean births compare between fetuses who achieved cephalic presentation through ECV and those who did so spontaneously?
How do the rates of cesarean births compare between fetuses who achieved cephalic presentation through ECV and those who did so spontaneously?
Which group is more likely to have a successful vaginal birth after a successful ECV?
Which group is more likely to have a successful vaginal birth after a successful ECV?
What is a significant consideration when evaluating the cost-effectiveness of ECV versus scheduled cesarean birth?
What is a significant consideration when evaluating the cost-effectiveness of ECV versus scheduled cesarean birth?
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Which of the following is NOT a risk associated with ECV?
Which of the following is NOT a risk associated with ECV?
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In the case of persistent breech presentation, which complication is potential?
In the case of persistent breech presentation, which complication is potential?
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What maternal risk is associated with planned cesarean birth?
What maternal risk is associated with planned cesarean birth?
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Which fetal/neonatal risk is associated with the procedure of cesarean birth?
Which fetal/neonatal risk is associated with the procedure of cesarean birth?
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What was the increase in the success rate of external cephalic version (ECV) after implementing a standardized protocol?
What was the increase in the success rate of external cephalic version (ECV) after implementing a standardized protocol?
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What does a forebag measurement greater than 1 cm indicate regarding ECV?
What does a forebag measurement greater than 1 cm indicate regarding ECV?
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In a study of 180,000 participants with breech fetuses, what was the cesarean birth rate for those who attempted ECV?
In a study of 180,000 participants with breech fetuses, what was the cesarean birth rate for those who attempted ECV?
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What was the cesarean birth rate after successful ECV in another study that included 2614 ECV attempts?
What was the cesarean birth rate after successful ECV in another study that included 2614 ECV attempts?
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What was the relative risk of cesarean birth for those with a successful ECV compared to cephalic-presenting fetuses?
What was the relative risk of cesarean birth for those with a successful ECV compared to cephalic-presenting fetuses?
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Which factor contributes to varying cesarean birth rates across different countries regarding ECV outcomes?
Which factor contributes to varying cesarean birth rates across different countries regarding ECV outcomes?
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What was the cesarean birth rate for those who experienced unsuccessful ECV attempts based on the same study?
What was the cesarean birth rate for those who experienced unsuccessful ECV attempts based on the same study?
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How does the cesarean birth rate for patients with successful ECV compare to the general obstetric population?
How does the cesarean birth rate for patients with successful ECV compare to the general obstetric population?
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What was the pooled complication rate reported for external cephalic version (ECV)?
What was the pooled complication rate reported for external cephalic version (ECV)?
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What is the pooled risk of stillbirth associated with ECV attempts?
What is the pooled risk of stillbirth associated with ECV attempts?
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What was the risk of emergency cesarean birth calculated from ECV attempts?
What was the risk of emergency cesarean birth calculated from ECV attempts?
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How many perinatal deaths occurred in the attempted ECV group in the systematic review mentioned?
How many perinatal deaths occurred in the attempted ECV group in the systematic review mentioned?
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What was the corrected perinatal mortality rate in the cohort of ECV attempts?
What was the corrected perinatal mortality rate in the cohort of ECV attempts?
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What complication had a pooled risk of 0.18 percent in ECV attempts?
What complication had a pooled risk of 0.18 percent in ECV attempts?
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Which factor showed no definite correlation to the risk of complications in ECV?
Which factor showed no definite correlation to the risk of complications in ECV?
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What percentage of the analyzed complications included abnormal fetal heart rate changes?
What percentage of the analyzed complications included abnormal fetal heart rate changes?
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Study Notes
External Cephalic Version (ECV)
- ECV is a procedure to rotate a fetus from a non-cephalic to a cephalic presentation.
- It's typically performed electively in non-laboring patients near term to increase the chances of vaginal birth.
- Success is influenced by maternal and fetal factors, including factors such as placenta position and amniotic fluid levels
Outcomes
- Success rates vary widely (22% to 76%).
- A meta-analysis of 84 studies (13,000 attempts) showed a pooled success rate of 58%.
- Reversion to breech presentation can happen in a small percentage of successful cases( 2.2% in one study ).
- Some patients have spontaneous version to cephalic presentation after an unsuccessful ECV. (4.3% in one study).
- ECV affects the rate of cesarean birth, as more fetuses remain in cephalic position at birth.
Factors that impede success
- Anterior, lateral, or cornual placenta position
- Low amniotic fluid volume
- Descent of breech into pelvis
- Female gender
- Non-palpable fetal head
- Firm maternal abdominal muscles
- Frank breech presentation
- Low birth weight
- Nulliparity (compared with parous patients)
- Obesity (especially high BMI)
Factors that enhance success
- Amniotic fluid index greater than 10 cm
- Complete breech position
- Non-longitudinal lie (oblique or transverse)
Unlikely and Controversial factors
- Larger fetuses (no evidence to avoid ECV if trial of labor planned)
- Nuchal cord (limited data regarding ECV and nuchal cord)
- HIV-positive patients (there is a theoretical low risk)
- Prior low transverse cesarean (not a contraindication, but individualized decision needed)
- Unengaged presenting part (forebag >1 cm is highly predictive of success in some research)
Timing
- Typically performed after 36 0/7 weeks gestation.
- Some clinicians may offer ECV earlier (34-35 weeks), but benefits must be weighed against risk of preterm birth.
- ECV can be performed later (39 weeks) if the fetus is in a nonlongitudinal lie.
Alternatives to ECV
- Expectant management.
- Postural maneuvers
- Moxibustion and acupuncture.
Risks Associated with ECV
- Stillbirth
- Abruption
- Emergency cesarean birth
Procedure
- Ultrasound examination before the procedure to evaluate fetal position and confirm gestational age.
- Evaluation of maternal well-being.
- ECV technique involves manipulating the fetus.
- Tocolysis may be used to relax the uterus
- Fetal heart rate monitoring is essential.
Postprocedure
- Fetal well-being monitoring (e.g., cardiac monitoring) is essential, including a reactive fetal heart rate response.
- Anti-D immune globulin (if needed)
- No elective induction
- Review of management strategies for unsuccessful ECV attempts and for patients with a persistent breech presentation after ECV
Management after an Unsuccessful ECV
- Reattempt ECV after 2 days if the first attempt was unsuccessful.
- Some patients have successful spontaneous version subsequent to failed ECV attempts.
- For persistent breech presentation after ECV, there are additional management guidelines.
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Description
This quiz covers the process and outcomes of External Cephalic Version (ECV), a procedure aimed at rotating a non-cephalic fetus to a cephalic presentation. It discusses success rates, influencing factors, and the implications of ECV on delivery outcomes. Test your knowledge on this vital obstetrical procedure.
