Tiêu đề external cephalic version new N2MR1.pdf ✅

External Cephalic Version and Reducing the Incidence of Term Breech Presentation Green-top Guideline No. 20a March 2017 Please cite this paper as: Impey LWM, Murphy DJ, Griffiths M, Penna LK on behalf of the Royal College of Obstetricians and Gynaecologists. External Cephalic Version and Reducing the Incidence of Term Breech Presentation. BJOG 2017; DOI: 10.1111/1471-0528.14466.
DOI: 10.1111/1471-0528.14466 External Cephalic Version and Reducing the Incidence of Term Breech Presentation This is the second edition of this guideline originally published in 2006. Executive summary of recommendations External cephalic version (ECV) How effective is ECV in preventing noncephalic birth? Women should be informed that the success rate of ECV is approximately 50%. A Women should be informed that after an unsuccessful ECV attempt at 36+0 weeks of gestation or later, only a few babies presenting by the breech will spontaneously turn to cephalic presentation. [New 2017] B Women should be informed that few babies revert to breech after successful ECV. [New 2017] B Women should be informed that a successful ECV reduces the chance of caesarean section. A Does ECV affect the outcome of labour? Women should be informed that labour after ECV is associated with a slightly increased rate of caesarean section and instrumental delivery when compared with spontaneous cephalic presentation. B Can the success of an ECV attempt be predicted? ECV success can be predicted to some extent, but the use of models to predict success should not be used routinely to determine whether ECV can be attempted. [New 2017] B What methods can be used to improve the success rate of ECV? Use of tocolysis with betamimetics improves the success rates of ECV. A Routine use of regional analgesia or neuraxial blockade is not recommended, but may be considered for a repeat attempt or for women unable to tolerate ECV without analgesia. [New 2017] B RCOG Guideline No. 20a 2 of 15 a 2017 Royal College of Obstetricians and Gynaecologists
When should ECV be offered? ECV should be offered at term from 37+0 weeks of gestation. B In nulliparous women, ECV may be offered from 36+0 weeks of gestation. What are the contraindications to ECV? There is no general consensus on the eligibility for, or contraindications to, ECV. C Women should be informed that ECV after one caesarean delivery appears to have no greater risk than with an unscarred uterus. [New 2017] C What are the risks of ECV? Women should be counselled that with appropriate precautions, ECV has a very low complication rate. B What measures are appropriate to ensure fetal safety? ECV should be performed where facilities for monitoring and surgical delivery are available. The standard preoperative preparations for caesarean section are not recommended for women undergoing ECV. Following ECV, EFM is recommended. Women undergoing ECV who are D negative should undergo testing for fetomaternal haemorrhage and be offered anti-D. [New 2017] D Who should perform ECV? ECV should only be performed by a trained practitioner or by a trainee working under direct supervision. [New 2017] How acceptable is ECV to women? Although most women tolerate ECV, they should be informed that ECV can be a painful procedure. C How could the uptake of ECV be increased? The uptake of ECV is best increased by timely identification of the baby presenting by the breech and provision of evidence-based information. C RCOG Guideline No. 20a 3 of 15 a 2017 Royal College of Obstetricians and Gynaecologists
How can an ECV service be developed and audited? There is no evidence to support any particular service model although larger institutions may consider a dedicated ECV clinic. [New 2017] What is the role of non-ECV methods? Women may wish to consider the use of moxibustion for breech presentation at 33–35 weeks of gestation, under the guidance of a trained practitioner. [New 2017] C Women should be advised that there is no evidence that postural management alone promotes spontaneous version to cephalic presentation. B 1. Purpose and scope External cephalic version (ECV) is the manipulation of the fetus, through the maternal abdomen, to a cephalic presentation. The purpose of this guideline is to describe and summarise the best evidence concerning methods to prevent noncephalic presentation at delivery and therefore, caesarean section and its sequelae. The evidence concerning mode and technique of the delivery of breech presentation is summarised in the Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 20b Management of Breech Presentation. 1 2. Introduction and background epidemiology Breech presentation complicates 3–4% of term deliveries and is more common in nulliparous women and in preterm deliveries. Following the publication of the Term Breech Trial,2 there was a significant decrease in the number of women undergoing vaginal breech birth.3 In many countries, including the UK, planned vaginal breech birth remains rare and attempts to prevent breech presentation at delivery remain important. 3. Identification and assessment of evidence This guideline was developed using standard methodology for developing RCOG Green-top Guidelines. The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects [DARE] and the Cochrane Central Register of Controlled Trials [CENTRAL]), EMBASE, MEDLINE and Trip were searched for relevant papers. The search was inclusive of all relevant articles published between August 2005 and April 2016. The databases were searched using the relevant Medical Subject Headings (MeSH) terms, including all subheadings and synonyms, and this was combined with a keyword search. Search terms included ‘breech’, ‘breech near presentation’, ‘breech presentation’, ‘breech near delivery’, ‘breech delivery’, ‘breech presentation and delivery’, ‘breech near extraction’, ‘breech extraction’, ‘Mauriceau-Smellie-Veit’, ‘Burns-Marshall’, ‘after-coming head’ and ‘external cephalic version’. The search was limited to studies on humans and papers in the English language. Relevant guidelines were also searched for using the same criteria in the National Guideline Clearinghouse and the National Institute for Health and Care Excellence (NICE) Evidence Search. Where possible, recommendations are based on available evidence. Areas lacking evidence are highlighted and annotated as ‘good practice points’. Further information about the assessment of evidence and the grading of recommendations may be found in Appendix I. RCOG Guideline No. 20a 4 of 15 a 2017 Royal College of Obstetricians and Gynaecologists