Freha Zafar, Ade Sanusi.
External cephalic version before elective Cesarean section for breech presentation.
Pak J Med Res Jan ;47(4):95-7.

Background: The Royal College of Obstetrics and Gynaecology guidelines state that all uncomplicated breech presentations should be offered external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version before undertaking the procedure. Objective: To ascertain the acceptability of external cephalic version before elective caesarean section for breech presentation by pregnant ladies and see whether they were adequately informed about the risks and benefits. Study design: The clinical audit was registered with the audit department at Watford general hospital and written consent for the access of medical records was obtained. A retrospective review of 86 accessible medical records out of total 110 elective breech caesarean sections was done over a period of one year. Duration of study: January to December 2006. Subjects and Methods: This retrospective study was conducted at the gynaecology and obstetrics department at Watford general hospital, Watford United Kingdom. Written consent for the access of medical records was obtained. All women who underwent elective caesarean section due to breech presentation were included in the study. Out of a total of 110 elective breech caesarean sections performed, the data on 86 cases was selected for the final analysis. The information gathered included patient’s profile, whether patient was informed of risks and benefits of external cephalic version, recognition of obstetric risk factors, external cephalic version performed and its success. Results: Out of total 86 caesarean sections 46 were suitable for external cephalic version of whom 37 cases were offered external cephalic version . Among 37 patients who were offered external cephalic version only 15 patients accepted (22 declined) the procedure. Moreover, it was found that the documentation of risk/benefit explanation of the procedure was inadequate. external cephalic version was not successful in any of the patient. Causes for unsuccessful external cephalic version were abdominal discomfort (5), inability to disengage fetus from pelvis (4), fetal bradycardia (3) and uterine irritability (3). Conclusion: External cephalic version was not successful in any of the cases in this study. However, to reduce the number of elective caesarean sections for breech presentation, external cephalic version should be offered to all women with uncomplicated breech presentation. Continuing medical education, dissemination of guidelines and regular clinical audit are necessary to improve the success rates of external cephalic version.

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