Cesarean delivery rates between fetus in cephalic presentation after a successful external cephalic version and those with spontenous cephalic presentation

Abstract

Background Breech presentation complicates 3-4% of all term singleton pregnancies. Morbidity and mortality in breech births is high. The incidence of caesarean section for breech presentation has increased markedly in the last 20 years. There is a consensus between health professionals and the authorities that recognizes the actual indexes of caesarean deliveries as excessive and in no case are they justified by an improvement in perinatal outcomes. Thus, reducing the caesarean section rates has become an objective of the majority of public health services. External cephalic version (ECV) refers to a procedure in which the fetus is rotated from a noncephalic to a cephalic presentation by manipulation through the mother's abdomen. External cephalic version (ECV) has been shown to be safe and effective as a preventive measure for reducing the number of BP at birth, as well as the number of CS because of breech presentation. The purpose of ECV is to decrease the incidence of both vaginal breech delivery and CS, without impacting upon maternal or fetal outcomes. Objective The aim of this study is to compare the caesarean delivery rates between foetus in cephalic presentation after a successful external cephalic version and those with spontaneous cephalic presentation in nulliparous, low-risk, pregnant women. Design The study will be a multi-centric prospective cohort, with a consecutive method of sampling among patients who attend the Ginecology and Obstetrics Service. Six different hospitals from Catalunya will participate in this trial. Methods The sample size will be 384 pregnant women at the 33-35 WG, whose foetuses are placed in cephalic or in breech position, and who meet all other inclusion and not the exclusion criteria. To do so, the patients will be classified in two groups according to their fetal presentation (seen in the ultrasound scan): Group 1 will include 192 patients whose foetuses are already in

Cesarean delivery rates between fetus in cephalic presentation after a successful external cephalic version and those with spontaneous cephalic presentation.

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vertex presentation and Group 2 will include 192 in breech position. Group 2 will undergo an external cephalic version to achieve a cephalic position. Both groups will be followed up until spontaneous labour appears. A vaginal delivery will be attempted. We will collect the number of caesarean deliveries (which is our main dependent variable) in

each group to do a statistical analysis and compare the percentages adjusted for all the co- variables