Pregnancy outcomes after external cephalic version

Na Klinici za ginekologiju i porodništvo, KB „Sv. Duh“ u četverogodišnjem razdoblju bilo je 11,684 porođaja. U istom razdoblju bilo je 355 (3.0%) terminskih fetusa u stavu zatkom, od čega je kod 74 (20.9%) fetusa pokušan vanjski okret, a uspješnih je bilo 57 (77.7%). Prema smjernicama RCOG-a predmnijeva se uspješnost zahvata 40% za prvorotke i 60% za višerotke, a visoka uspješnost zahvata na Klinici može se protumačiti velikim udjelom višerotki (70.2%). U literaturi učestalost spontane reverzije na zadak kreće se oko 5%, dok u ovom istraživanju nije bio zabilježen niti jedan takav slučaj. Niti u jednom slučaju u istraživanoj skupini nije zabilježena neposredna, teška komplikacija zahvata kao što su fetalna smrt, abrupcija posteljice ili hitni carski rez. U istraživanoj skupini zabilježen je samo jedan slučaj intrapartalne, marginalne, subkliničke abrupcije posteljice, a razlika u učestalosti abrupcije posteljice između skupina nije nađena (1.4% vs 0.4%). U istraživanoj (n=57) i kontrolnoj (n=240) skupini nije nađena statistički značajna razlika za dob, indeks tjelesne mase i prirast na masi tijekom trudnoće. U drugim istraživanjima udio vaginalnih porođaja nakon vanjskog okreta kreće se od 66.7% do 79.4%, a u učestalost vaginalnih porođaja na Klinici u obje skupine bila je podjednaka (82.5% vs 85.0%). U istraživanoj skupini bilo je više rotacijskih i defleksijskih anomalija (14.0% vs 5.0%, p=0.015), što nije uzrokovalo veću učestalost vakuum ekstrakcija, epiziotomija i razdora međice u istraživanoj skupini. Autori u pojedinačnim istraživanjima navode učestalost carskog reza u rasponu od 14.7% do 33.3%, a u meta-analizi na ukupnom uzorku od 45,641 navodi se dvostruko veći rizik za carski rez nakon vanjskog okreta (20.7% vs 10.9%, OR 2.2). Na Klinici je učestalost carskog reza bila podjednaka u obje skupine (17.5% vs 15%). Kod 298 porođaja na zadak učestalost carskog reza bila je 94.9%, a u istraživanoj skupini bila je 17.5%. Primjenom vanjskog okreta smanjen je apsolutni rizik za carski rez za 77.4% (0. 949-0.175=0.774.). Proizlazi da je potrebno učiniti dva uspješna okreta kako bi se izbjegao jedan carski rez (NNT=1/0.774=1.3). Nije bilo razlike u porođajnoj masi fetusa i ocjeni vitalnosti prema Apgar indeksima. Niti jedan fetus u istraživanoj skupini nije imao Apgar ocjenu ispod 7.In the studied four-year period at the Department for Gynecology and Obstetrics of the University Hospital „Sveti Duh“ there were 11,684 births. During that period there were 355 (3.0%) cases of term breech presentation. In 74 (20.9%) cases an external cephalic version (ECV) was attempted, with a successful outcome in 57 (77.7%) cases. According to the RCOG guidelines, the success rate in primiparous women is about 40%, and about 60% in multiparous. The high success rate at our Department is probably due to 70.2% of the study group being multiparous women. The incidence of spontaneous reversion to breech is 5%, but in our study not one was detected. Following ECV attempts, we didn't encounter any immediate significant complications such as fetal death, placental abrution or emergency Cesarean section (CS). In the study group, there was just one case of intrapartum, marginal placental abruption, with low clinical significance. No significant difference in placental abruption incidence (1.4% vs 0.4%) was detected between the groups. There were no significant differences between the study (n=57) and control (n=240) group in age, body mass index and weight gain during pregnancy. Other studies report an incidence of vaginal deliveries after ECV between 66.7% and 79.4%. We found a similar vaginal delivery rate in both groups (82.5% vs 85%). In the study group, there was a higher incidence of fetal malpresentations such as occipitoposterior position and extended fetal head (14.0% vs 5.0%, p=0.015). Nevertheless, that finding didn't lead to a higher incidence of vacuum extraction, episiotomy or perineal rupture. Other authors report a CS rate between 14.7% and 33.3%, whereas in a metha-analysis on 45,641 women undergoing an ECV attempt, a two-fold higher risk for CS was found (20.7% vs 10.9%, OR 2.2). In both our groups there was a similar rate of cesarean sections (17.5% vs 15%). In 298 cases of breech delivery, the CS rate was 94.9%, compared to only 17.5%, after successful ECV. Thus, ECV achieved a 77.4% CS reduction rate (0.949-0.175=0.774). Two women needed to have a successful ECV in order to prevent one cesarean birth (NNT=1/0.774=1.3). There was no difference in fetal birth weight and Apgar scores, between the two groups. All newborns had an Apgar score >7