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ECV may be more successful when done early. (Clinically Significant Trend).

WINNIPEG, MAN. -- Physicians who attempt external cephalic version of a breech fetus at 34-36 weeks' gestation may have slightly more success than those who attempt it at 37-38 weeks, according to the results of the Early External Cephalic Version Trial.

Although the results of the trial did not show a statistically significant difference in the success rate based on the timing of the procedure, there was a clinically significant trend toward a higher success rate when the procedure was performed earlier, said Eileen Hutton, principal investigator for the multicenter, international trial.

A total of 233 women from seven countries who had breech presentations were randomized to external cephalic version (ECV) at 34-36 weeks' gestation or 37-38 weeks. Women who underwent ECV early had a 9.5% reduction in noncephalic presentation at birth and a 7% reduction in cesarean section rates, compared with those who had late ECV, she said at the annual meeting of the Society of Obstetricians and Gynecologists of Canada.

"We now need to go to a larger trial to make sure the finding is a true one and not just a chance finding. This study had a significance value of 0.09, which means there's a 9% chance that the finding was just by chance," she said in an interview.

Interest in ECV has grown enormously in recent months, fueled by the results of the Term Breech Trial. In that study, planned cesarean section for breech pregnancies was associated with a lower rate of perinatal and neonatal mortality and serious neonatal morbidity, compared with planned vaginal delivery (1.6% vs. 5%).

"The results of the Term Breech Trial have meant that the majority of women with breech babies are now going to be offered cesarean sections, whereas previously the majority of practitioners were offering them vaginal breech births. In light of this, ECV is very important because it is one of the few strategies out there right now to avoid sections. If you manage to get the baby turned head down at least there's an opportunity for a vaginal birth," said Ms. Hutton of Sunny-brook and Women's College Health Sciences Centre, Toronto.

Ms. Hutton's group released another study at the same meeting showing that Canadian physicians have dramatically changed their practices as a result of the Term Breech Trial.

Among the almost 600 physicians surveyed, only 6% now recommend vaginal breech birth for nulliparous women, compared with 65% who did so before the trial. And just 12% recommend it for multiparous women, compared with 83% before the study was published.

In addition, 89% of those surveyed now recommend ECV Of these physicians, 62% do it themselves, and 38% refer the patient to someone else for the procedure.

The physicians surveyed reported an estimated success rate of 30% for ECV in nulliparous women and 55% in multiparous women.

The survey found that ECV is usually begun at 37 weeks' gestation, and that only 14% of those who do ECV offer repeat procedures when the first one fails. Among the physicians who perform ECV themselves, 53% never use tocolytics, and among the 47% who do, 55% use them selectively and 45% use them routinely.

Ninety-one percent of those who perform ECV never use analgesia. Among the 9% who do use it, 79% use it selectively and 21% use it routinely.

"Obstetric care providers may increase the likelihood of success with ECV by increasing their use of tocolyrics, considering the use of analgesics and considering repeat procedures when the initial attempt fails," Ms. Hutton said.
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Author:Johnson, Kate
Publication:OB GYN News
Date:Aug 1, 2002
Previous Article:Fetal infection triggers systemic inflammation, preterm labor. ('Hostile Intrauterine Environment').
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