External cephalic version at term: how high are the stakes?

Article Abstract:

When babies are born, they are said to have either a cephalic (head-first) or breech (buttocks-first) presentation, depending on which part is positioned to move first down the birth canal. Cephalic presentations occur as many as 25 times as often as breech presentations, a fortunate state of affairs, since the latter is associated with a higher complication rate. In the past, to correct breech presentation, some obstetricians tried to turn the fetus several weeks before delivery (at 30 to 34 weeks' gestation). This approach, known as external cephalic version (ECV), fell out of favor in the mid-1970s because of perceived increases in fetal mortality and the increasing safety of cesarean section for breech delivery. ECV at later stages (after the 37th week of pregnancy), however, has several advantages over the earlier procedure: in case of complications, delivery of a mature infant can take place rapidly; other complications, if any, are already apparent; and, fetuses that will turn spontaneously, have already done so. The effectiveness and safety of ECV at term are discussed. At term, it reduces the incidence of cesarean birth and breech delivery considerably. In one hospital that rarely used ECV, 18 percent of all cesarean sections were done because of breech presentation, which occurred in only 3.3 percent of all pregnancies. It is estimated that, in the UK, every 100 ECV attempts could prevent 34 breech births and 14 cesarean sections. Under current obstetrical practice, the risks to the fetus of term ECV are slight, and must be balanced against the risks of sudden delivery or rupture of the membranes surrounding the fetus (both occur more often with breech presentation after 37 weeks' gestation), and the risks of vaginal breech delivery, which often necessitates the use of forceps and surgical enlargement of the birth canal (episiotomy). Randomized trials of ECV at term have demonstrated its effectiveness in reducing cesarean deliveries and breech births; although fetal risk data are not complete, indications are that the procedure adds no significant risk. Additional research on the subject is well warranted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Breech delivery, Fetal presentation, Breech birth, Labor, Complicated, Labor complications, editorial

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Should abdominal compression be consigned to the history books?

Article Abstract:

Poor fetal growth can be attributed to an inadequate blood supply to the uterus. The current accepted management of pregnancies complicated by impaired fetal growth is to deliver the fetus early before more damage is done. There are no effective interventions that improve the blood flow to the placenta. Intermittent pressure applied to a pregnant abdomen, abdominal decompression, reduces the resistance of the abdominal muscle wall, which then causes the uterus to more forward. This technique is thought to improve blood flow through the placenta, the organ of fetal nutrition. Studies performed in the early 1960s suggested that abdominal decompression maneuvers could improve fetal growth and promote intellectual development. Intelligence was tested children at four weeks, nine months and three years of age. However, further examination of the test results could not distinguish between the effects of the technique and the preconceived expectations of the parents who believed that the decompression technique improved intelligence. Reexamination of those birth records found no statistical difference between the study and comparison groups with respect to birthweight and Apgar scores (an assessment of fetal well-being at one and five minutes after birth). However, abdominal decompression may be of some benefit in pregnancies that are complicated by fetal distress, high blood pressure, poor fetal growth, as it may relieve the pain of labor. A study performed by Varna and Curzen in 1973 found that abdominal decompression reduced the frequency of low birthweight. Two other studies supported these results and the three studies together indicated a significant reduction in fetal death after decompression. It is concluded that these limited but significant results should be not be ignored but investigated further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects

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Abdominal decompression: new data from a previous study

Article Abstract:

In the early 1950s the technique of abdominal decompression was developed to decrease the force and pain of labor and to improve the blood flow through the placenta. Intermittent pressure applied to a pregnant abdomen reduces the resistance of the abdominal muscle wall, which then causes the uterus to more forward. To relieve labor pains, the decompression apparatus is worn by the patient, who controls the action of a pump to coincide with labor contractions. Since this technique is thought to also improve blood flow through the placenta, the organ of fetal nutrition, it may improve the outcome of pregnancies complicated by poor fetal growth. Studies examining the benefits of abdominal decompression have produced varying results. In 1968 a study was performed by the African National Institute for Personnel Research (NIPR) which examined the beneficial effects of abdominal decompression. The group examined the developmental scores of children born to mothers undergoing the maneuver during their pregnancies, and compared them with those of children whose mothers had not received decompression. The scores, which were slightly higher in the decompression group, were not statistically significant. The hospital records of 253 women enrolled in that study were traced and re-examined to look at the effects of decompression on uncomplicated pregnancies. The birth weights, the length of pregnancy, the rate of assisted delivery and Apgar scores, a measurement of fetal well-being taken at one and five minutes after birth, were similar in both groups. Although abdominal decompression may be of benefit to compromised pregnancies, there is no evidence that the maneuver benefits normal pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

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