Abstract：Objective To investigate the influencing factors of successful external cephalic version (ECV) for breech presentation at term under epidural anesthesia. Methods The clinical data on 368 cases of singleton pregnant women with breech presentation who had undergone ECV at 37-40 gestational weeks between January 2015 and February 2021 was analyzed retrospectively. According to the outcomes of ECV, these women were divided into the success group and failure group. Both groups received ECV under B-ultrasound monitoring after epidural anesthesia. The maternal age, parity, gestational weeks, maternal body mass index before pregnancy, use of drugs for tocolysis, neonatal weight, placenta positions, umbilical cord entanglement, lengths of umbilical cords, and types of breech presentation on ECV were compared between the two groups. Results (1)The success rate of ECV was 41.30%(152/368), and the vaginal delivery rate in the success group was 82.24%(125/152). (2) Univariate analysis showed that there was no significant difference in age, gestational weeks, maternal body mass indexes before pregnancy, umbilical cord entanglement, umbilical cord lengths, or types of breech presentation between the two groups (P>0.05). However, there was significant difference in parity, use of tocolysis drugs, neonatal weight and placenta positions between the two groups (P<0.05). Multivariate logistic regression analysis suggested that multiparity (OR=2.485, 95%CI 1.499-4.121), neonatal weight ≥3000 g (OR=4.335, 95%CI 2.470-7.607), use of of tocolysis drugs (OR=8.183,95%CI 4.668-14.348) were independent favorable factors for the success of ECV. Conclusions The application of ECV in pregnant women with breech presentation at term can reduce the rate of cesarean section significantly. The independent influencing factors that contribute to the success of ECV include multiparity, the use of tocolysis drugs, and neonatal weight.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins Obstetrics. Practice bulletin No. 221: external cephalic version[J]. Obstet Gynecol, 2020, 135(5):e203-e212.
[6]
Ebner F, Friedl T W, Leinert E, et al. Predictors for a successful external cephalic version: a single centre experience[J].Arch Gynecol Obstet, 2016,293(4):749-755.
[7]
Hutton E K, Simioni J C, Thabane L. Predictors of success of external cephalic version and cephalic presentation at birth among 1253 women with non-cephalic presentation using logistic regression and classification tree analyses[J]. Acta Obstet Gynecol Scand, 2017, 96(8):1012-1020.
[8]
Weill Y, Pollack R N. The efficacy and safety of external cephalic version after a previous caesarean delivery[J]. Aust N Z J Obstet Gynaecol, 2017, 57(3): 323-326.
[9]
Vaz de Macedo C, Clode N, Mendes da Graça L, et al. Prediction of success in external cephalic version under tocolysis: still a challenge [J]. Acta Med Port, 2015, 28(5): 554-558.
[10]
Cluver C, Gyte G M, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version[J]. Cochrane Database Syst Rev,2015, 9(2) : CD000184.
[11]
Trobo D,Pintado P,Ortega V, et al. Maternal and perinatal outcomes in external cephalic version: prognostic factors for the success of the technique[J]. J Perinat Med, 2019, 47(7):717-723.
[12]
Isakov O, Reicher L, Lavie A, et al.Prediction of success in external cephalic version for breech presentation at term[J]. Obstet Gynecol,2019, 133(5):857-866.
[13]
Kok M, Van der Steeg J W, Van der Post J A, et al. Prediction of success of external cephalic version after 36 weeks[J].Am J Perinatol, 2011, 28( 2) : 103- 110.
Hao Q, Hu Y, Zhang L, et al. A Systematic review and meta-analysis of clinical trials of neuraxial, intravenous, and inhalational anesthesia for external cephalic version [J]. Anesth Analg, 2020, 131(6):1800-1811.
[16]
Magro-Malosso E R, Saccone G, Di Tommaso M, et al. Neuraxial analgesia to increase the success rate of external cephalic version: a systematic review and meta-analysis of randomized controlled trials [J]. Am J Obstet Gynecol, 2016, 215(3): 276-286.
2021, Vol. 32 
