Publication: 10 years review of successful external cephalic version (ECV) at Hospital Raja Perempuan Zainab II (HRPZII)
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Date
2022
Authors
Makhtar, Nurul Ain Sah
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Abstract
Objectives: To determine the proportion of patients with successful ECV in breech pregnancy from 36-40 weeks of gestation, the predictors for successful ECV and to create a predictor tool to assist in term of counseling of patients before ECV. Study design: This single center retrospective based on clinical records reviewed 479 medical records with singleton pregnancies and breech presentations that experienced ECV attempt at Hospital Raja Perempuan Zainab II from January 2010 to December 2019 between 36 to 40 weeks of gestation. Variables with a possible effect on ECV success were collected. These variables include gestation, parity, body mass index (BMI), types of breech, fetal parameters, engagement of buttock, well flexed fetal head, and amniotic fluid index (AFI). Variables’ association with ECV success was assessed using a multivariate logistic regression and predictor tool was created. Results: Overall, 479 clinical records of women underwent ECV being reviewed and success rate of the ECV was 54.7%. Flexed breech (p= 0.007), multiparity (p= 0.000), unengaged of fetal buttock (p=0.000), smaller head circumference (p= 0.017) and higher amniotic fluid index (AFI) (p=0.002) were the independent factors of the version success, while other variables had no statistically significant effect on the success rate. Preoperative predictive score had been created which consist of parity, types of breech, body mass index (BMI), amniotic fluid index (AFI) and engagement of buttock with the minimum score of 8 and maximum score of 13. The favourable predictor score is 9 and above. Conclusion: The overall successful rate for ECV performed in HRPZ II is analogous to other studies and ECV should be offered as an option for the mother. Recognized fetal and maternal factors can help to estimate the chances of success and prediction tool enables accurate prediction of successful ECV and in which when the score is more than 8, it is high chance that the ECV will be successful.
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