Abstract
Objectives
To present the consequences of and risk factors for abnormal bleeding after ECV (external cephalic version).
Methods
We conducted a retrospective chart review at a single center in Japan. Abnormal bleeding was defined as vaginal bleeding and/or intrauterine hemorrhage. We descriptively assessed birth outcomes among women with abnormal bleeding, and investigated the risk factors using a logistic regression analysis.
Results
Of 477 women who received ECV, 39 (8.2%) showed abnormal bleeding, including 16 (3.4%) with intrauterine hemorrhage. Of the 16 women with intrauterine hemorrhage, 14 required emergency cesarean section; none experienced placental abruption, a low Apgar score at 5 min (<7), or low umbilical cord artery pH (<7.1). Among 23 women who had vaginal bleeding without intrauterine hemorrhage, four cases underwent emergency cesarean section and one case of vaginal delivery involved placental abruption. The risk of abnormal bleeding was higher in women with a maximum vertical pocket (MVP) of <40 mm in comparison to those with an MVP of >50 mm (adjusted odds ratio [OR]: 3.48, 95% confidence interval [CI]: 1.23–9.90), as was higher in women with unsuccessful ECV than in those with successful ECV (aOR: 4.54, 95% CI: 1.95–10.6).
Conclusions
A certain number of women who underwent ECV had abnormal bleeding, including vaginal bleeding and/or intrauterine hemorrhage, many of them resulted in emergency cesarean section. Although all of cases with abnormal bleeding had good birth outcomes, one case of vaginal bleeding was accompanied by placental abruption. Small amniotic fluid volume and unsuccessful ECV are risk factors for abnormal bleeding.
Acknowledgments
The authors are deeply grateful to all of the participants in the present study and to the hospital staff for their cooperation. We would also like to thank the following members of an ECV team: Terumi Miwa, Yukiko Tazaki, and Fumio Suyama. The authors would also like to thank Mr. Brian Quinn, for proofreading and editing this manuscript.
-
Research funding: None declared.
-
Author contributions: HM and KO initiated the concept, designed the study, and collected the data, and KO analyzed the data. HM wrote the initial manuscript. AO and HS gave critical comments on the study design and interpretation and revised the draft.
-
Competing interests: All the authors have no conflicts of interest to disclose.
-
Informed consent: Informed consent was obtained from all individuals included in this study.
-
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the Institutional Review Board of the NCCHD on Nov. 15, 2018 (No 1990).
References
1. Hofmeyr, GJ, Kulier, R, West, HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2015:CD000083.10.1002/14651858.CD000083.pub3Search in Google Scholar PubMed PubMed Central
2. Mahomed, K, Seeras, R, Coulson, R. External cephalic version at term. A randomized controlled trial using tocolysis. BJOG 1991;98:8–13.10.1111/j.1471-0528.1991.tb10303.xSearch in Google Scholar PubMed
3. Collaris, RJ, Oei, SG. External cephalic version: a safe procedure? A systematic review of version-related risks. Acta Obstet Gynecol Scand 2004;83:511–8.10.1111/j.0001-6349.2004.00347.xSearch in Google Scholar PubMed
4. Grootscholten, K, Kok, M, Oei, SG, Mol, BW, van der Post, JA. External cephalic version-related risks: a meta-analysis. Obstet Gynecol 2008;112:1143–51.10.1097/AOG.0b013e31818b4adeSearch in Google Scholar PubMed
5. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins--Obstetrics. Practice bulletin No. 161: external cephalic version. Obstet Gynecol 2016;127:e54–61.10.1097/AOG.0000000000001312Search in Google Scholar PubMed
6. Impey, LWM, Murphy, DJ, Griffiths, M, Penna, LK. on behalf of the Royal College of Obstetricians and Gynaecologists. Management of breech presentation. BJOG 2017;124:e151-77.10.1111/1471-0528.14465Search in Google Scholar PubMed
7. Suyama, F, Ogawa, K, Tazaki, Y, Miwa, T, Taniguchi, K, Nakamura, N, et al.. The outcomes and risk factors of fetal bradycardia associated with external cephalic version. J Matern Fetal Neonatal Med 2017;922–6.10.1080/14767058.2017.1395846Search in Google Scholar PubMed
8. Rodgers, R, Beik, N, Nassar, N, Brito, I, de Vries, B. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. BJOG 2017;124:767–72.10.1111/1471-0528.14169Search in Google Scholar PubMed
9. Brocks, V, Philipsen, T, Secher, NJ. A randomized trial of external cephalic version with tocolysis in late pregnancy. BJOG 1984;91:653–6.10.1111/j.1471-0528.1984.tb04825.xSearch in Google Scholar PubMed
10. Cluver, C, Gyte, GM, Sinclair, M, Dowswell, T, Hofmeyr, GJ. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev 2015:Cd000184.10.1002/14651858.CD000184.pub3Search in Google Scholar PubMed PubMed Central
11. Dugoff, L, Stamm, CA, Jones, OW3rd, Mohling, SI, Hawkins, JL. The effect of spinal anesthesia on the success rate of external cephalic version: a randomized trial. Obstet Gynecol 1999;93:345–9.10.1016/S0029-7844(98)00456-6Search in Google Scholar
12. Dyson, DC, Ferguson, JE2nd, Hensleigh, P. Antepartum external cephalic version under tocolysis. Obstet Gynecol 1986;67:63–8.Search in Google Scholar
13. Schorr, SJ, Speights, SE, Ross, EL, Bofill, JA, Rust, OA, Norman, PF, et al.. A randomized trial of epidural anesthesia to improve external cephalic version success. Am J Obstet Gynecol 1997;177:1133–7.10.1016/S0002-9378(97)70029-2Search in Google Scholar
14. Elsasser, DA, Ananth, CV, Prasad, V, Vintzileos, AM. Diagnosis of placental abruption: relationship between clinical and histopathological findings. Eur J Obstet Gynecol Reprod Biol 2010;148:125–30.10.1016/j.ejogrb.2009.10.005Search in Google Scholar PubMed PubMed Central
© 2021 Walter de Gruyter GmbH, Berlin/Boston
