cephalic presentation telugu

Cephalic Meaning In Telugu

సాధారణ ఉదాహరణలు మరియు నిర్వచనాలతో cephalic యొక్క నిజమైన అర్థాన్ని తెలుసుకోండి., definitions of cephalic.

1 . తలలో లేదా సంబంధించినది.

1 . in or relating to the head.

Examples of Cephalic :

1 . మొదటి దశను "సెఫాలిక్ దశ" అంటారు.

1 . the first phase is called the" cephalic phase.".

2 . ఈ సంభావ్యతలో పెరుగుదల ప్రగతిశీలమైనది మరియు ఈ కాలంలో బ్రీచ్ మరియు సెఫాలిక్ ప్రెజెంటేషన్‌లకు సమానంగా ఉంటుంది.

2 . the increase of this probability is gradual and identical for breech and cephalic presentations during this period.

3 . 36 వారాల గర్భధారణ సమయంలో సంక్లిష్టమైన బ్రీచ్ గర్భంతో ఉన్న స్త్రీలకు బాహ్య సెఫాలిక్ వెర్షన్‌ను అందించాలి.

3 . women who have an uncomplicated singleton breech pregnancy at 36 weeks of gestation should be offered external cephalic version.

4 . నియోనాటల్ సెఫాలిక్ స్ఫోటము: జీవితం యొక్క మొదటి రోజులలో కనిపించే డెర్మటోసిస్, మొటిమల మాదిరిగానే ముఖం లేదా నెత్తిమీద పస్ట్యులర్ దద్దుర్లు కనిపించడం ద్వారా వర్గీకరించబడుతుంది.

4 . neonatal cephalic pustule: dermatosis that appears in the first days of life, characterized by the appearance of a pustular eruption on the face or scalp, similar to acne.

5 . బాహ్య సెఫాలిక్ వెర్షన్ విరుద్ధంగా ఉంటే లేదా విఫలమైతే, సిజేరియన్ అందించాలి, ఎందుకంటే ఇది పెరినాటల్ మరణాలు మరియు నవజాత శిశువుల అనారోగ్యాన్ని తగ్గిస్తుంది.

5 . if external cephalic version is contra-indicated or has been unsuccessful, caesarean section should be offered because it reduces perinatal mortality and neonatal morbidity.

6 . మొదటి కాలంలో, ఇది గర్భం యొక్క 24వ వారం వరకు కొనసాగుతుంది, ఈ అబద్ధం యొక్క బ్రీచ్ లేదా సెఫాలిక్ ప్రెజెంటేషన్‌ల సమాన నిష్పత్తితో రేఖాంశ అబద్ధం యొక్క సంభవం పెరుగుతుంది.

6 . during the first period, which lasts until the 24th gestational week, the incidence of a longitudinal lie increases, with equal proportions of breech or cephalic presentations from this lie.

7 . పాము తన తలపై ఉదారంగా ఉంటుంది, దొంగ తన కుటుంబంలో దాతృత్వాన్ని సృష్టిస్తాడు, దొంగ తన స్నేహాన్ని ఇక్కడ దొంగిలించడు, బ్రాహ్మణుడు తన కుల శ్రేయస్సు కోసం కట్టుబడి ఉంటాడు, సన్యాసి ఔదార్యాన్ని మాత్రమే సృష్టిస్తాడు, మనిషి లేదా చీమ లేని జీవితం రెండింటి మధ్య తేడా లేదు.

7 . the snake is generous for its cephalic , the robber generates generosity in his family, the thief does not steal his acquaintance here, the brahmin remains engaged in the welfare of his caste, the monk generates generosity only, the life free of man or the ant there is no difference between the two.

8 . సెఫాలిక్ సిర చేతిలో ఉంది మరియు ఆక్సిలరీ సిరలోకి ప్రవహిస్తుంది.

8 . The cephalic vein is located in the arm and drains into the axillary vein.

Similar Words

Cephalic meaning in Telugu - Learn actual meaning of Cephalic with simple examples & definitions. Also you will learn Antonyms , synonyms & best example sentences. This dictionary also provide you 10 languages so you can find meaning of Cephalic in Hindi, Tamil , Telugu , Bengali , Kannada , Marathi , Malayalam , Gujarati , Punjabi , Urdu.

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Management of Labour and Delivery – Questions

Rekha Wuntakal, Madhavi Kalidindi, Tony Hollingworth in Get Through , 2014

For each clinical scenario below, choose the single most appropriate stage of labour from the above list of options. Each option may be used once, more than once or not at all. A 30-year-old para 3 woman was admitted at term with regular uterine activity at 5 cm cervical dilatation and 4 hours later she delivered a female neonate with APGARs 9, 10, 10 at 1, 5 and 10 minutes. Syntometrine injection was given immediately after delivery and placenta with membranes was delivered completely 20 minutes after the delivery of the baby by continuous cord traction.A 23-year-old para 3 woman was admitted after spontaneous rupture of membranes at 39 weeks’ gestation. She is contracting 4 in 10 minutes and pushing involuntarily. On vaginal examination the cervix was fully dilated, vertex was 2 cm below the spines in direct occipito-anterior position with minimal caput and moulding.A 30-year-old nulliparous woman was admitted at term with uterine contractions once in every 5 minutes. On examination, the fetus is in cephalic presentation with two fifths palpable per abdomen. The cervix is central, soft, fully effaced and 2 cm dilated with intact membranes.

Biometric Measurements and Normal Growth Parameters in a Child

Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child , 2021

In cephalic presentation, the intra-uterine fetal position is of universal flexion, which is carried by the child to the immediate post-partum period. The hips and knees are flexed. The lower legs are internally rotated. The feet are further internally rotated with respect to the lower legs. At times there is an external rotational contracture of the hip that tends to mask the true femoral rotational profile. The anatomy of the lower limbs changes significantly as the child grows. This is primarily in response to the development of motor abilities and the ability of the child to crawl, cruise, stand, walk, and finally run. These changes are seen right from the hip joints, the femoral neck, knees, and tibia to the feet.

DRCOG MCQs for Circuit A Questions

Una F. Coales in DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips , 2020

External cephalic version: Used to convert a breech presentation to cephalic presentation.Not contraindicated if there is a prior Caesarean section scar.Can cause premature labour.Contraindicated in hypertension.Can be performed after 33 weeks' gestation in a rhesus-negative mother.

Complex maternal congenital anomalies – a rare presentation and delivery through a supra-umbilical abdominal incision

Published in Journal of Obstetrics and Gynaecology , 2018

Samantha Bonner, Yara Mohammed

She had a spontaneous conception and booked at 9 weeks of gestation under consultant-led care. A scan confirmed the pregnancy was in the right uterus. She had no other significant medical history but did suffer from recurrent urinary tract infections and hence was on low-dose antibiotic prophylaxis. There was no sonographic evidence of hydronephrosis. Her body mass index (BMI) was 18 at the time of booking. Combined screening was low risk and she had a normal 20 week anomaly scan. She had serial growth scans which demonstrated a normal growth trajectory on a customised chart. The baby was consistently a cephalic presentation. She had multidisciplinary antenatal care, including specialist urologists, general surgeons, obstetricians and anaesthetists. An antenatal MRI scan had shown extensive adhesions over the lower segment of the uterus. She was extensively counselled regarding the mode of delivery and this was scheduled at 37 weeks of gestation to avoid the potential of spontaneous labour and an emergency Caesarean section.

Utilization of epidural volume extension technique for external cephalic version

Published in Baylor University Medical Center Proceedings , 2021

Hanna Hussey, James Damron, Mark F. Powell, Michelle Tubinis

Repeat ultrasound demonstrated breech presentation, normal amniotic fluid volume, and fetal head toward the maternal left abdomen. After 0.25 mg of intramuscular terbutaline injection, a forward roll was initiated by applying pressure from behind the fetal head toward the maternal left. Continuous progress was made and bedside ultrasound showed cephalic presentation. Immediately after successful ECV, the fetal heart rate was 70 beats/min but returned to baseline with conservative measures. Motor blockade regressed after approximately 1.5 hours. After 4 hours of fetal heart rate monitoring and tocometry, the patient was deemed stable for discharge. Follow-up discussion with the patient via phone call on postprocedure day 1 confirmed that she was not experiencing pain or concerning symptoms for neuraxial complications. She returned to the labor and delivery unit at 40 weeks’ gestation for elective induction of labor and had a successful vaginal delivery.

Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section

Aida Kalok, Shahril A. Zabil, Muhammad Abdul Jamil, Pei Shan Lim, Mohamad Nasir Shafiee, Nirmala Kampan, Shamsul Azhar Shah, Nor Azlin Mohamed Ismail

The inclusion criteria were pregnant women at 36 weeks of gestation or more with singleton foetus in cephalic presentation, who agreed for trial of vaginal delivery after one lower segment caesarean section. We excluded women with contraindication for vaginal birth, or who declined trial of vaginal delivery from this study. Previous antenatal history was noted and recorded during the 36-week assessment, including year and indication for previous caesarean section. Recurrent indications involved were cephalopelvic disproportion and obstructed labour. While non-recurrent indications were foetal distress and malpresentation. Past operative notes were checked for any operative complications such as extended uterine tear, organ injury and post-partum haemorrhage. Information regarding current pregnancy including pre-existing medical disorder was recorded. Estimated foetal weight based on ultrasound scan at 36 weeks of gestation was used in this study.

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English Telugu Dictionary | ఇంగ్లీషు తెలుగు నిఘంటువు

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cephalic - Meaning in Telugu

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Cephalic adjective.

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• English - Telugu

Telugu Meaning of 'cephalic'

Meaning of 'cephalic', related phrases.

• cephalic vein చేతి పైభాగపు సిర
• cephalic presentation పుట్టబోయే శిశువుయొక్క తల దర్శనమగుట
• eury cephalic వెడల్పైన శిరస్సు

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Single loop of cord around neck

Share this page, hi doctor, in my 31 week scan it was found single loop umbilical cord around fetal neck. is it dangerous are there remedies.

6575 Views v

...  Read More

Single loop of cord is around baby neck. Does it affect normal delivery or my baby

Asked for Female, 26 Years 45736 Views v

Sometimes it affects. By chance if it compresses during delivery, it ll be very dangerous ...  Read More

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I am 39 weeks pregnant and I have single loop of cord around neck of my baby. Tomorrow I have my c section scheduled. Is it harmful to baby? Will it cause any problem in heart beat and the oxygen supply to baby. Kindly advise I am so much worried

Asked for Female, 31 Years 64 Views v

it wont cause any problem ...  Read More

My wife is 29 weeks pregnant, took the obstetric ultrasound scan . There it is mentioned as "single loop of cord around neck" What it is? Is it dangerous? Do we need to consult doctor on this? Attached the report Thanks!

Asked for Male, 29 Years 18099 Views v

A loose loop of cord lying across the neck is very common and not at all dangerous ...  Read More

I am 35 week pregnant today i Did sonography and its observed that my baby neck Have single loop of cord. I am too much worried about that.

Asked for Female, 25 Years 32238 Views v

Follow your Obstetrician ...  Read More

I am 38 week pregnant but have single loop of cord around fetal. Will it affect normal delivery or baby?

Asked for Female, 35 Years 6177 Views v

Connect with me for online consultation for details BeBorn Gynecology Santacruz Mumbai ...  Read More

Hi, I am in 29th week of my pregnancy. I got a color doppler done to know the growth of my baby. Report says "normal low resistance flow waveforms of uterine arteries with good diastolic flow. No diastolic notch is seen. Umbilical artery shows normal waveforms with good diastolic flow. MCA shows normal waveforms." Is my baby getting good blood supp

Asked for Female, 32 Years 3310 Views v

It is not dangerous...but you have to be vigilant of fetal movement count ...since color doppler blood flow is normal you don't have to worry about blood supply... ...  Read More

I had a growth scan and we found out that baby has a single loop of cord around neck. I am very worried as it is just the starting of third trimester and cord is already around neck. Kindly suggest what impact will it have? What do I need to do?

Asked for Female, 34 Years 1645 Views v

Nothing to worry about. Single loop of cord doesn't harm mostly. Just follow up with your doctor as required. ...  Read More

In my recent colour Doppler scan doc identified single loop cord around my baby's neck. Does it cause any harm to baby or baby's growth? Does normal delivery possible or should I go for C section.. please help me.. I'm very much worried since this scanning.

Asked for Female, 27 Years 4072 Views v

consult for more discussion on ur problem and treatment chat privetly ...  Read More

Today i am done with Doppler scan, it's my 34 week 5 days, in report all normal, only showing , single loose loop around the neck , is it dangerous or normal, what can I do to prevent from this ,? Can it will go away by the delivery time?

Asked for Female, 30 Years 625 Views v

Its normal, nothing to worry, keep note of baby movements thats all ...  Read More

I am 38 weeks pregnant and in latest ultrasound, one loop of nuchal cord around neck of baby is detected. Should I wait for labour pain and go for normal delivery or better to go for elective c section. My pelvic muscles are already tight as mentioned by doctor.

Asked for Female, 25 Years 27 Views v

Theoretically you should wait for the labour pains. Till about 50 years ago when Ultrasound was not readily available the Doctor could never diagnose a cord around the neck and everyone was allowed ...  Read More

Hi doctor, I am 32 weeks 5 days pregnant and baby weight is 1990 grams. I have 2 queries - 1. My AFI level is 7.79. How can I increase it? Can I deliver normally with low AFI as well? 2. USG shows single loop of cord. Is this normal? Can I deliver normally with this?

Asked for Female, 34 Years 128 Views v

You will have to connect for a prescription There is no specific medicine to help increase the af i levels Delivering normally at this Afi is highly unlikely Nothing to worry about the single loop ...  Read More

In my USG scan it's mentioned *There is a single loop of cord not completely surrounding the neck* Is it a cause of concern in future...what can I do to avoid it completely going round the neck...I am currently 31 wks pregnant

Asked for Female, 28 Years 47 Views v

Pls connect for online consultation and advice ...  Read More

I am 36 weeks & went for a growth scan today. I begin my 37weeks tomorrow. Results are otherwise okay. AFI is 125. Heart beat is 130. Weight is 2.7kg. But the USG specialist mentioned there is a single loose loop around the neck. Is that a cause for concern ? Does it mean a C sec?

Asked for Female, 39 Years 57 Views v

No single loose loop does not mean a c section, normal delivery can be done Bt keep a check on baby movements ...  Read More

Hi Doctor, If there is 3 loops around in 8.5 month or 32 week 5 days. What is the right week for operation please suggest.

Asked for Female, 28 Years 143 Views v

Connect please ...  Read More

It's my 9th month running and and there is a single cord around baby's neck. Is there any possibility of normal dilivery?

Asked for Female, 29 Years 329 Views v

There are various conditions that determine mode of delivery, not just single loop of cord around neck. Depending on the situation at the time of delivery your mode of delivery will be decided. With ...  Read More

Currently 35+ weeks pregnant. Recent USG Report shows single loop of cord around the neck. Is there any risk to baby due to this. Do I need to follow any precautions for this.

Asked for Female, 34 Years 584 Views v

It's noticed many a times during the scan.Not to worry. Keep a watch on Baby movements. ...  Read More

My wife is now 39 th week of pregnancy and in scan report it came as there is a 2 loop of cord around the neck of the baby consultation doctor told that we can do only csection normal delivery is complication please give me some advice in this case

Asked for Male, 38 Years 647 Views v

The reason fr cesarean is less liquor n iugr Not 2 loops of cord around the neck Liquor is less that's a matter of concern The weight of the baby though seems to be normal 2 loops of cord is not a ...  Read More

Hi mam, In my 9th month growth scan, I noticed Single loop of cord around one side of the neck. Does that mean the cord is round the neck or near the neck? Please tell me

Asked for Female, 25 Years 263 Views v

It is a very common finding. It doesn't always mean a cord around the neck. If you go into labour and have a smooth progress then there is no problem. If you have a prolonged labour then we have to ...  Read More

I am 31 week pregnant .my baby's neck is around by single loop cord.is it any problem.baby is in cephalic presentation

Asked for Female, 27 Years 427 Views v

No problem.. ...  Read More

I am 37 weeks pregnant and ultrasound shows double cord loop around baby's neck . Please suggest if normal delivery possible. My doc suggested for c section.. i don't want to opt for it..

Asked for Female, 31 Years 881 Views v

Definitely possible with strict fetal heart monitoring in labour ...  Read More

Hello Doc, Wife got USG done at 36W-1D. Report is attached. It says cord around neck. Should we get induced and get baby delivered or wait for pains? Is cord around neck danger to baby if stays in womb for long. Secondly growth of baby is 1 week behind. Is that also a cause of concern? Her BP, Sugar, Hb all ok. 11 kg weight increase since start b

Asked for Male, 31 Years 225 Views v

Consult please. ...  Read More

Is everything ok related to my pregnancy..i am very scared about the cord... How can i resolve this problem

Asked for Female, 25 Years 253 Views v

My wife is 9 month pregnant, 36.5 weeks. We have done one USG AFI, EBW and doppler. AFI has been reduced to 8 cm. In last month it was 13 cm. Also, single cord found surrounding babys neck. Other doppler results are normal. How much probablity of normal delivery is safe in this situation? Her due date is 27th sept

Asked for Male, 33 Years 218 Views v

In 29 weeks of preg in year scan it is observed baby is in breech position and single loop of cord. Doc said not so worry since baby can move still and position will change. But is there any chance for single loop of cord to get removed or it will stay till delivery ?

Asked for Female, 30 Years 599 Views v

It might get released. Position also changes till 32 weeks. Nothing to worry about. ...  Read More

Hi. Iam in my 28 weeks and in doppler scan it says two loops of cord around fetal neck. Is this serious? While iam repeating scan after 1 week but really worried. What care should I take?

Asked for Male, 37 Years 553 Views v

Please don't worry unnecessarily. You need not repeat the scan after one week. The scan should be repeated when it is due. Two loops of the cord around the neck at 28 weeks means nothing because ; a) ...  Read More

My wife anamoly scan done at 20th week says single loose loop around the neck of baby.. What is this and something to be worried

Asked for Male, 30 Years 260 Views v

Nothing to worry about. ...  Read More

Hello Doctor's, In my 28week growth scan, it's mentioned double loop around baby's neck. Baby is in cephalic presentation. Weight is 1.2kg and Heartbeat is 148. Will there be any problem for baby as there is still time for delivery?? Thanks and Regards

Asked for Female, 32 Years 260 Views v

Too far too think. Follow up scan will be done. And two loops of cord should mot be a concern for delivery ...  Read More

Ultrasound report is attached.water level is low and a cord arround neck.gynac suggest for seissors..and tell no other alternative.and weight of child is remain same ( before 20 days ultrasound report) while in previous ultrasound there is no cord,adequate water...plz sujjest

Asked for Female, 26 Years 100 Views v

Go for Lscs ...  Read More

I am 36 weeks pregnant, in my last usg it is discovered that my baby has double loops of cord around neck, is normal delivery possible in this case? Is it safe to deliver a baby normally with double loops of cord around neck??

Asked for Female, 29 Years 2034 Views v

Normal delivery is possible but it is dangerous. Baby having cord around the neck twice was not unknown before 1980 (when Ultrasound came to India) , but it was never diagnosed before delivery. So all ...  Read More

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External Cephalic Version—A Chance for Vaginal Delivery at Breech Presentation

Ionut marcel cobec.

1 Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Diakoniestrasse 10, 74523 Schwäbisch Hall, Germany

Vlad Bogdan Varzaru

Tamas kövendy, lorant kuban, anca-elena eftenoiu.

2 Clinic of Internal Medicine, Hohenloher Krankenhaus Öhringen, 74613 Öhringen, Germany

Aurica Elisabeta Moatar

Andreas rempen.

Background and Objectives : In recent years, the rate of caesarean section (CS) has increased constantly. Although vaginal breech delivery has a long history, breech presentation has become the third most common indication for CS. This study aims to identify factors associated with the success of external cephalic version (ECV), underline the success rate of ECV for breech presentation and highlight the high rate of vaginal delivery after successful ECV. Material and Methods : This retrospective observational study included 113 patients with singleton fetuses in breech presentation, who underwent ECV from January 2016 to March 2021 in the Clinic of Obstetrics and Gynecology, Diakonieklinikum Schwäbisch Hall, Germany. Maternal and fetal parameters and data related to procedure and delivery were collected. Possible predictors of successful ECV were evaluated. Results : The success rate of ECV was 54.9%. The overall rate of vaginal birth was 44.2%, regardless of ECV outcome. The vaginal birth rate after successful ECV was 80.6%. Overall, 79.0% of women with successful ECV delivered spontaneously without complications, 19.4% delivered through CS performed during labor by medical necessity, and 1.6% delivered through vacuum extraction. ECV was performed successfully in three of the four women with history of CS. Gravidity, parity, maternal age, gestational age, fetal weight, and amniotic fluid index (AFI) were significantly correlated with the outcome of ECV. Conclusions : ECV for breech presentation is a safe procedure with a good success rate, thus increasing the proportion of vaginal births. Maternal and fetal parameters can be used to estimate the chances of successful ECV.

1. Introduction

In recent years, the rate of caesarean section (CS) has increased constantly in Germany [ 1 ]. In singleton pregnancies, an important indication of CS has been fetal malpresentation. In clinical practice, breech presentation (praesentation caudae) is the most common abnormal fetal presentation, which refers to fetuses lying bottom- or feet/knee-first rather than head-first [ 2 ]. Breech presentation is defined as a longitudinal positioning of the fetus with the buttocks or feet closest to the cervix. In Germany, fetal breech presentation at term occurs in about 3% of singleton pregnancies. The rate of breech presentation decreases with gestational age. This rate is about 9% between 33 and 36 pregnancy weeks, 18% between 28 and 32 weeks, and about 30% before the 28th pregnancy week [ 3 ].

The predisposing factors for breech presentation are uterine anomalies (e.g., uterus arcuatus, uterus bicornis, uterus duplex), uterus myomatosus, pelvic tumor, advanced multiparity, history of cesarean delivery or breech delivery, gestational diabetes, multiple gestation, congenital anomalies of the fetus (neural tube defects, fetal hydrocephalus or anencephaly), neuromuscular diseases, cephalo-pelvic disproportion, prematurity, low fetal birth weight, oligohydramnios, short umbilical cord, polar placentation, and placenta praevia [ 4 , 5 ]. However, in about 75% of cases, no specific cause of term breech presentation could be identified [ 4 , 6 ]. The main types of breech presentation are frank (≈60–70%), complete (≈4–10%), and incomplete breech (≈20–36%) [ 7 , 8 ].

Vaginal breech delivery has a long history. Studies have shown that perinatal and neonatal mortality rates, as well as serious neonatal morbidity rates, were higher in the planned vaginal delivery than in the planned cesarean delivery at breech presentation [ 9 ]. These findings significantly lead to CS being accepted by obstetricians as the safer option for breech delivery [ 9 ].

In the United States, there has been an increase in the frequency of CS in the past 20 years. One in three women giving birth in the USA will undergo a CS [ 10 ]. In many other developed and developing countries, this rate is the same. For example, in Korea, the frequency of CS was about 36.9% in 2012, CS being the usual method of delivery for term breech presentation [ 11 ]. Breech presentation became the third most common indication for CS, after previous CS and labor dystocia [ 12 ].

The maternal morbidity of CS is approximately three times higher than that of vaginal delivery [ 13 ]. The maternal risks of CS compared to vaginal delivery are well known. These include greater blood loss, thrombotic events, unplanned hysterectomy, operative damage to other organs, mortality, longer hospital stay with higher costs, and more readmissions than patients undergoing vaginal delivery [ 14 ]. Additional maternal complications of CS include scarring, chronic pain, and intestinal obstruction caused by adhesive disease. Moreover, in the following pregnancies, a previous cesarean delivery may cause a higher rate of placental abnormalities, unexplained stillbirth, as well as repeated surgical delivery in many cases [ 14 ]. However, vaginal delivery could also have maternal complications compared to CS, such as postpartum urinary incontinence and pelvic organ prolapse [ 15 ].

In case of fetal breech position, the external cephalic version (ECV) could be an option for reducing the number of CSs and vaginal breech deliveries [ 9 ]. ECV is a technique used to convert the fetal breech presentation into a cephalic position with targeted manual pressure on the mother’s abdominal wall at-term or near-term pregnancies in order to increase the chance of a vaginal cephalic birth [ 9 , 16 , 17 ]. ECV can be carried out with or without analgesics and with or without tocolytic therapy [ 18 ].

Factors favoring the success of ECV could be multiparous women, non-anterior placental location, palpability of the fetal skull, lower maternal body mass index, the type of breech presentation (for example, the frank breech presentation is associated with lower rates of success) and, of course, the experience of the physician in performing ECV [ 10 , 18 , 19 ]. Placental abruption, vaginal bleeding, fetal injury (including fractures and brachial plexus injuries), and pathological cardiotocography (CTG) findings, such as fetal bradycardia, may represent complications of the method [ 20 ].

The aim of this study is to identify factors associated with the success of ECV, highlight the relevance and success rate of ECV for breech presentation, and underline the high rate of vaginal deliveries in patients with successful ECV for breech presentation.

2. Material and Methods

This study represents a retrospective and anonymized data analysis over a period of 5 years. We reviewed the records of 113 women who underwent ECV from January 2016 to March 2021 in the Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Germany. In our study, we included all patients with singleton fetuses in breech presentation who agreed to the maneuver. The ECV was performed by different senior consultants. Prior to ECV, an ultrasound control was performed, and the possible risks of the maneuver were discussed. Each patient signed the ECV informed consent. ECV was not performed if the patient rejected ECV or if there were absolute contraindications of ECV.

For 30 min before and during the ECV, the patient received an infusion with tocolysis with fenoterol. Before and after the ECV, a CTG control was performed. The ECV was attempted under ultrasound control of the fetal heartbeat. Fetal biometric parameters were obtained sonographically. The patient was placed in a comfortable lying position with knees slightly elevated. The patient was allowed to end the maneuver at any point in time.

Maternal age, number of pregnancies, number of childbirths, history of CS, ultrasonographic findings (type of breech presentation, placental location, amniotic fluid index), characteristics of ECV (gestational age at ECV, fetal weight at ECV, success of ECV, direction in which successful ECV was performed, complications during and after ECV), and birth-related characteristics (planned and real type of delivery, gestational age at birth, fetal weight at birth) were collected from our database. Data were analyzed using IBM SPSS Statistics 20. Grouping by the dichotomous outcome of ECV, we used either χ 2 analysis or Fisher’s exact test for categorical variables and independent samples t -test for continuous variables. Multiple binary logistic regression was used to identify possible predictors of the outcome of ECV. We used the significance threshold of α = 0.05 corresponding to the 95% confidence interval.

In the observed five years, we registered 6619 singleton deliveries out of a total of 6825 deliveries and a general CS rate of 24.9%. Overall, 11.0% were elective CSs and 13.9% CSs were performed during labor by medical necessity. In total, 4.8% of all registered deliveries in our clinic in the observed period were CSs with breech presentation. In our sample of 113 women, the mean maternal age was 31.69 years ( SD = 4.44)—the youngest patient was 18 years old and the oldest patient was 43 years old. In total, 53.1% of the women were primigravida and 61.9% were nullipara. Four (3.5%) women had a history of CS.

Before ECV was performed, the fetal back faced the maternal left in 60 (53.1%) cases and the maternal right in 53 (46.9%) cases. In 56 (49.6%) cases, the placenta was located on the posterior wall, in 47 (41.6%) on the anterior wall, in 6 (5.3%) in the fundus, and in 4 (3.6%) on the left or right wall. The mean amniotic fluid index (AFI) at ECV was 14.88 ( SD = 3.58), ranging from 8 to 25. The mean gestational age at ECV was 261.82 days ( SD = 4.98). The minimum gestational age at ECV in our cohort was 35 + 2 weeks of pregnancy and the latest performed ECV was at 40 + 0 weeks of pregnancy. In 12 cases (10.6%), ECV was performed under 37 weeks of gestation because of medical necessity and with informed patient consent. The mean fetal weight at ECV was 2966.02 g ( SD = 391.06), ranging from 2158 g to 4123 g.

The success rate of ECV was 54.9%. ECV succeeded backwards in 39 (62.9%) cases and forwards in 23 (37.1%) cases. Overall, 101 (89.4%) of the ECVs were performed without any complications during the maneuver. In total, 12 (10.6%) cases encountered complications during the attempt of ECV. The complications were represented by fetal bradycardia with quick recovery in 7 cases, maternal intolerable abdominal pain in 2 cases, vena cava compression with quick recovery in 1 case, low maternal tocolysis tolerance in 1 case, and maternal nausea and emesis in 1 case. A single patient (0.9%) developed contractions during post-ECV monitoring, while 112 patients (99.1%) had no complications post-ECV.

The overall rate of vaginal birth was 44.2%, regardless of ECV outcome. The successful ECV group was planned for spontaneous delivery. The vaginal birth rate of the successful ECV group was 80.6%. Out of 62 patients, 49 (79.0%) delivered spontaneously without complications, 12 (19.4%) delivered through CS performed during labor by medical necessity, and 1 (1.6%) delivered through vacuum extraction. ECV was performed successfully in three of the four women with history of CS; three delivered through CS and one delivered vaginally. The unsuccessful ECV group delivered through CS.

For gestational age and fetal weight at birth, eight observations were excluded from the analysis due to missing values. Five patients were planned for CS and decided to deliver in another clinic, while three patients were planned for spontaneous delivery and decided upon home birth. The mean gestational age at birth was 275.41 days ( SD = 8.96), the earliest delivery was at 37 + 0 weeks of pregnancy and the latest was at 42 + 0 weeks of pregnancy. The mean fetal weight at birth was 3350.43 ( SD = 470.69), ranging from 2180 g to 4470 g.

We analyzed the relationship between the outcome of ECV and the following categorical variables: gravidity, parity, history of CS, fetal back position before ECV and placental location ( Table 1 ). Multigravidity, defined as having been pregnant more than once, and a parity ≥ 1 were significantly associated with a successful ECV.

Association between outcome ECV and gravidity, parity, history of CS, fetal back position before ECV and placental location.

We compared maternal age, gestational age, fetal weight and AFI at ECV for successful and unsuccessful ECV using an independent samples t -test and found significant differences ( Table 2 ). For gestational age, we conducted a Welch’s t -test since equal variances could not be assumed. The other continuous variables were compared using Student’s t -test.

Comparison between maternal age, gestational age at ECV, fetal weight at ECV and AFI at ECV for successful and unsuccessful ECV using independent samples t -test.

Multiple logistic regression analysis was used to construct a prediction model for the outcome of ECV and covariates parity, maternal age, gestational age at ECV, fetal weight at ECV and AFI at ECV ( Table 3 ). A parity ≥ 1 and a higher maternal age were found to be favorable predictors of successful ECV in our prediction model.

Results of multiple logistic regression analysis for predictors of successful ECV.

4. Discussions

This study was performed in a clinic where the CS rate is lower than the reported CS rate for Germany, which is about 31.8% according to the official statistics [ 3 ]. In 2000, a large international multicenter randomized clinical trial, called the Term Breech Trial, compared vaginal deliveries with planned cesarean deliveries [ 21 ]. It was shown that perinatal and neonatal mortality rates, as well as serious neonatal morbidity rates, were significantly higher in the planned vaginal delivery group than in the planned cesarean delivery group (16% vs. 5%) at breech presentation. These findings significantly led to obstetricians choosing CS as the safer option for breech delivery in the 2000s [ 9 ]. For this reason, more than 12% of the CSs in Germany are performed in case of breech presentation. For example, in the west-central part of Germany, in the State of Hessen, about 90% of breech fetuses at term are delivered via CS [ 3 ]. In our clinic, CS at breech presentation represented 4.8% of all registered deliveries from 2016 to 2020.

In case of fetal breech position, ECV could be a successful and safe option to reduce the number of CSs [ 22 , 23 ]. The routine use of ECV could lower the rate of surgical delivery in case of breech presentation by approximately two-thirds in term pregnancies [ 9 ]. In most cases, fenoterol is used as tocolytic therapy, mainly as a continuous tocolysis. The improvement of the monitoring during the ECV with sonography and CTG and the use of tocolytic therapy made this method safer, thus reducing the complication rate associated with ECV [ 18 ].

By performing ECV, we aim to increase the proportion of vaginal cephalic delivery and thereby decrease the rate of CSs. For these reasons, ECV can be considered the first-line management in dealing with uncomplicated breech presentation at term. The method is recommended by Cochrane and the American and Royal Colleges of Obstetrics and Gynecologists, as well as by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe) [ 3 , 24 , 25 ].

ECV would be generally recommended after 37 weeks of gestation [ 9 , 16 ]. It is performed as an elective procedure in non-laboring women, aiming to improve the chance of vaginal cephalic birth. Attempting ECV before term, between 34th and 36th pregnancy weeks, can be associated with an increase in late preterm birth [ 17 ]. According to the German guidelines, ECV should be offered to all women with uncomplicated breech presentation by singleton pregnancies in hospitals where facilities for an emergency CS are present [ 3 , 20 ]. In a study performed by Weiniger et al., the CS rate among women with successful ECV was 20.2%, whereas among women with persistent breech presentation at delivery it was 94.9% [ 26 ]. We registered a CS rate for successful ECV of 19.4%, while the unsuccessful ECV patients delivered through CS.

Furthermore, women who underwent vaginal delivery after a successful ECV had lower odds of developing endometriosis and sepsis and shorter hospitalization, therefore lower hospital charges [ 26 ]. In contrast, these women could have a higher risk of chorioamnionitis. Attempted ECV may be also associated with an increased risk of a low APGAR score at 5 min [ 6 ]. According to the literature, the absolute risk of all complications of ECV is approximately 1% in fetuses at term [ 14 ]. We noticed in our study that the registered complications were minimal and insignificant compared to the high rate of successful ECV, followed by a high rate of vaginal deliveries.

Women with singleton pregnancy and breech presented fetus without the following pathologies are potentially eligible for ECV near term (≥36 weeks). These pathologies include multiple gestation, onset of active labor, rupture of membranes, oligohydramnios, antepartum hemorrhage or history with placental abruption, pelvic abnormalities, severe preeclampsia or eclampsia, pathological Doppler or CTG, placenta praevia, placenta accreta, and infant with major congenital anomalies or growth restrictions [ 2 ].A point system, such as Kainer score, can be helpful to estimate the success rate of ECV, which includes parameters, such as AFI, placental location, fetal position, nuchal cord, estimated fetal weight, parity, fetal engagement, and uterine tone [ 27 , 28 ]. We noticed positive results even though we did not apply this score.

Multiparous women are known to have higher ECV success rates [ 9 ]. Our study shows that multigravidity and a parity ≥ 1 are associated with successful ECV. The absence of nulliparity was also identified as an important predictor of successful ECV, which supports the findings of previous studies.

According to the literature, ECV is considered safe in women with a history of CS and some studies showed that the success rate of ECV is comparable to that of women with no previous CS [ 29 , 30 , 31 , 32 ]. Although rare, we registered four cases with a history of CS. ECV was successful in three of them, but only one delivered vaginally. In our sample, the fetal back faced either the maternal left or right. We found no statistically significant relationship between the fetal position and the outcome of the maneuver.

The anterior placental location has been reported as being associated with a lower rate of success, probably due to the anterior location of the placenta making it difficult to perform ECV [ 9 ]. In the present study, we included patients with anterior, posterior, lateral, and fundal placental location. We noticed that the relationship between placental location and ECV outcome was not significant.

Our study included women between 18 and 43 years old. The group with successful ECV had a higher mean maternal age than the group with unsuccessful ECV, therefore we included maternal age in our logistic regression analysis. In our prediction model, higher maternal age was found to be a predictor for successful ECV, therefore the success rate increases with maternal age. Other studies did report similar results [ 33 , 34 ]. It is important to note that there may be other related variables affecting this relationship, for example, BMI, which we did not take into account. According to the literature, high BMI values are associated with a low success rate of ECV and a decrease in the rate of vaginal delivery after successful ECV [ 35 ].

The relationship between estimated fetal weight at ECV and ECV outcome is controversial [ 9 , 34 ]. We found an association between the success of the maneuver and higher fetal weight, as well as higher gestational age at ECV. An explanation could be that a larger fetus, which corresponds to a higher gestational age, is more palpable [ 27 , 36 ].

It has been reported that a higher AFI is associated with successful ECV [ 18 , 37 , 38 ]. In the present study, the group with successful ECV had a higher mean AFI than the group with unsuccessful ECV. It is important to note that the minimum AFI score registered was eight.

The safety, efficacy, and cost-effectiveness of ECV for breech presentation followed by vaginal delivery are underlined in our study through good clinical practice and are sustained by other performed studies [ 2 ].

5. Conclusions

ECV for breech presentation is a safe procedure with a good success rate which increases the proportion of vaginal births. Maternal and fetal parameters can be used to estimate the chances of successful ECV. Multigravidity, absence of nulliparity, higher maternal age, higher gestational age, higher fetal weight, and higher AFI are all associated with successful ECV.

Funding Statement

This research received no external funding.

Author Contributions

I.M.C. and A.R. conceived and planned in detail the present study. I.M.C., V.B.V. and T.K. extracted and analyzed the entire patient data. A.-E.E. performed the computations and interpreted the patient data together with I.M.C., L.K., V.B.V. and A.E.M., I.M.C. took the lead in writing the manuscript with input from T.K., V.B.V., A.-E.E. and A.E.M., in consultation with A.R., I.M.C. and A.R. supervised this study. All authors discussed the results and commented on the manuscript. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

This study used pre-existing, anonymized and irreversibly de-identified data. Approval from the ethics committee was not required.

Informed Consent Statement

This retrospective study used pre-existing, anonymized and irreversibly de-identified data.

Conflicts of Interest

The authors declare no conflict of interest.

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