The importance of external version in breech presentation on frequency of caesarean section

master's thesis

• Title (croatian): Značenje zahvata vanjskog okreta fetusa u stavu zatkom na učestalost carskog reza
• Author: Eva Drevenšek
• Mentor: Josip Juras (mentor)
• Committee member: Josip Juras (predsjednik povjerenstva)
• Committee member: Vito Starčević (član povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

External cephalic version is a procedure in which fetus is manually turned into a cephalic presentation. Its importance lies in the fact that there is a high rate of caesareans section in breech presentation and this technique is used to achieve a cephalic position in which chances for a vaginal birth increase and the risk of caesarean section can be reduced. It is useful in breech and other non-cephalic presentations. It can be done at term or before term. Although recommended, its use it still not implemented widely, as some women are not offered a try and some refuse it. The success rate of external version varies greatly between different studies, it is estimated to be 58% and it depends on many factors such as parity and position of placenta and many others. The use of tocolysis and neuraxial anesthesia also increases the success rates, especially when used in conjunction. Successful external version does decrease the rate of caesarean births, but women presenting with non-cephalic presentations still have higher risk of caesarean section even after a successful external version then women presenting with spontaneous cephalic presentations. At the Department for Obstetrics and Gynecology at University Hospital Center Zagreb, in the period between 2016 and 2018, external version was successful in 56.6 percent of trials and 90 percent of women with successful version gave birth vaginally, which illustrated that with implementation of external cephalic version the rate of caesarean sections could be decreased. Contraindications of external version are arguable, with different sources stating varying states and diagnoses as contraindications. Some examples are fetal distress and uterine bleeding. External cephalic version is a safe procedure with low complication rates, but it does have some risks and rare serious complications. Studies showed that external version is cost-effective.

Abstract (croatian)

Vanjski okret postupak je u kojem se fetus manualno iz stava zatkom prevodi u stav glavom. Njegova je važnost u činjenici da postoji velika stopa carskog reza pri prezentaciji zatkom te da spomenuti zahvat, kada je uspješno obavljen, povećava šanse za vaginalni porođaj te smanjuje rizik od carskog reza. Zahvat je koristan pri stavu zatkom, ali i ostalim stavovima koji ne uključuju glavu. Može se učiniti prije termina i u terminu. Iako se zahvat preporučuje, njegova se upotreba još uvijek ne primjenjuje učestalo, nekim se ženama ne nudi pokušaj, a neke odbijaju. Stopa uspješnosti vanjskog okreta uvelike varira između različitih studija, procjenjuje se da iznosi 58% i ovisi o mnogim čimbenicima kao što su paritet i položaj posteljice te mnogi drugi. Korištenje tokolize i neuraksijalne anestezije također povećava stopu uspješnosti, posebno kada se koriste zajedno. Uspješan vanjski okret smanjuje stopu carskih rezova, no žene s fetusima u stavu drugačijem od glave fetusa i dalje imaju veći rizik od carskog reza čak i nakon uspješno izvedenog vanjskog okreta u odnosu na žene s fetusima u stavu glavom. U Klinici za ženske bolesti i porode KBC-a Zagreb, u razdoblju između 2016. i 2018. godine, vanjski okret bio je uspješan u 56,6 % sudionica, a 90 % žena s uspješnim vanjskim okrtom rodilo je vaginalno. Takav podatak govori u prilog smanjenju carskog reza primjenom vanjskog okreta. Kontraindikacije za vanjski okret sporne su, a različiti izvori navode različita stanja i dijagnoze kao kontraindikacije. Neki su primjeri fetalni distres i krvarenje iz maternice. Vanjski okret siguran je postupak s niskom stopom komplikacija, ali ima određene rizike i rijetke ozbiljne komplikacije. Studije govore u prilog isplativosti vanjskog okreta.

• Keywords: external cephalic version; caesarean section; breech presentation
• Keywords (croatian): vanjski okret; carski rez; stav zatkom
• Language: english
• URN:NBN: urn:nbn:hr:105:945759
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-12-21 08:29:33