Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc
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Original Article

Volume 9, Number 1-2, June 2020, pages 3-11

Regional Differences in External Cephalic Version and Management of Vaginal Breech Delivery: A Survey in the Netherlands

Tables

Table 1. Characteristics of Centers and Gynecologists
 
No. (%) of responders
ECV: external cephalic version.
Type of centers
  General hospital33 (51)
  Teaching hospital24 (37)
  Academic hospital8 (12)
Special interest
  Obstetrics51 (78)
  Other14 (22)
Existence of written guideline for ECV
  Yes59 (91)
  No6 (8)
Existence of written guideline for breech delivery
  Yes55 (85)
  No10 (15)

 

Table 2. ECV
 
No. (%) of responders
ECV: external cephalic version; EDA: epidural analgesia.
Is ECV offered?
  Yes, offered to > 90% of patients with breech presentation64 (98)
  Yes, offered to > 50% of patients with breech presentation1 (2)
Minimum term for ECV
  34 weeks of gestation2 (4)
  35 weeks of gestation16 (36)
  36 weeks of gestation27 (60)
  No answer20
Maximum term for ECV
  37 weeks of gestation4 (6)
  38 weeks of gestation9 (14)
  39 weeks of gestation8 (12)
  40 weeks of gestation11 (17)
  41 weeks of gestation10 (15)
  42 weeks of gestation21 (33)
  No answer2 (3)
Maximum number of separate ECV attempts
  16 (9)
  249 (75)
  38 (12)
  42 (3)
By whom is ECV performed (multiple answers possible)?
  Obstetrician57 (89)
  AIOS (resident)15 (23)
  Clinical midwife35 (55)
  ANIOS (pre-registration house officer/intern)3 (5)
  Midwife12 (19)
  No answer1
Is ECV performed by one or two people?
  Always one12 (19)
  Always two23 (36)
  Variable29 (45)
  No answer1
Time taken for an ECV
  < 15 min13 (20)
  15 - 30 min39 (60)
  30 - 45 min12 (18)
  No answer1 (2)
Setting of an ECV attempt
  During a special ECV outpatient clinic22 (35)
  ECV is conducted during regular outpatient appointment10 (15)
  ECV is conducted in the clinic29 (44)
  Other4 (6)
Local ECV registration
  Yes46 (73)
  No17 (27)
  No answer2
Center success rate of ECV in general
  < 25%2 (3)
  25-50%38 (60)
  50-75%23 (37)
  No answer2
Center success rate of ECV on primigravidae
  < 25%9 (14)
  25-50%37 (58)
  50-75%5 (8)
  Unknown13 (20)
  No answer1
Center success rate of ECV on multigravidae
  25%0 (0)
  25-50%13 (20)
  50-75%31 (48)
  > 75%7 (11)
  Unknown14 (22)
Center success rate after a first failed attempt by a midwife in primary care
  < 25%9 (14)
  25-50%10 (16)
  70-75%0 (0)
  > 75%0 (0)
  Unknown45 (70)
  No answer1
Is electronic fetal monitoring performed before ECV?
  Yes, always61 (95)
  Yes, sometimes2 (3)
  No, never1 (2)
  No answer1
Is electronic fetal monitoring performed after ECV?
  Yes, always65 (100)
Uterine relaxant offered for ECV
  Yes, with every attempt35 (54)
  Yes, only with primigravidae1 (2)
  Yes, from the second attempt4 (6)
  Yes, under other conditions10 (15)
  No15 (23)
If yes, which uterus relaxants?
  Atosiban23 (46)
  Fenoterol9 (18)
  Ritodrine16 (32)
  Nifedipine2 (4)
Administration of pain relief for ECV
  Yes1 (2)
  No64 (98)
If yes, which painkiller?
  EDA1 (100)
  Remifentanil0 (0)
If no, if pain relief would be effective, would you offer it?
  Yes56 (88)
  No8 (12)

 

Table 3. Breech Delivery
 
No. (%) of responders
PRN: Perinatale registratie Nederland.
Does your center offer vaginal breech deliveries?
  Yes65 (100)
Amount of started planned vaginal breech deliveries in 2016
  < 55 (8)
  5 - 1528 (43)
  15 - 3020 (31)
  > 3012 (19)
How did you come to this answer?
  Through the annual report9 (14)
  Through a national registration15 (23)
  It is an estimation41 (63)
Percentage ended in cesarean delivery
  < 25%5 (8)
  25-50%40 (63)
  50-75%17 (27)
  > 75%1 (2)
  No answer2
Percentage of women with breech presentation opting for elective cesarean delivery
  < 25%2 (3)
  25-50%8 (13)
  50-75%25 (39)
  > 75%29 (45)
  No answer1
How did you come to this answer?
  The annual report7 (11)
  PRN9 (14)
  It is an estimation48 (75)
  No answer1
Breech deliveries in an upright position
  Yes19 (29)
  No46 (71)
Inducing delivery when indicated in case of breech position
  Yes47 (72)
  No18 (28)
Labor augmentation in breech presentation
  Yes53 (83)
  No11 (17)
  No answer1
Options for pain relief during breech delivery
  Yes, epidural anesthesia, remifentanil or other pain-relieving medication49 (75)
  Yes, only epidural anesthesia16 (25)
  Yes, only remifentanil0 (0)
  No0 (0)
Epidural administration prophylactically given during breech delivery
  Yes2 (3)
  No63 (97)
Limited number of gynecologists that supervises a breech delivery
  Yes18 (28)
  No47 (72)
Operation team present in the hospital during a planned vaginal breech delivery
  Yes28 (43)
  Yes, from the latest part of dilatation phase24 (37)
  No13 (20)
Operation team informed about the presence of a breech delivery
  Yes35 (56)
  No28 (44)
  No answer2
Operation team informed about the start of the second stage
  Yes42 (65)
  No23 (35)
Vaginal breech delivery possible in case of in premature delivery
  No5 (8)
  Yes, with every term39 (61)
  Yes, from 34 weeks of gestation17 (27)
  Yes, from 35 weeks of gestation2 (3)
  Yes, from 36 weeks of gestation1 (2)
  No answer1
Way of counselling a premature pregnant woman with breech presentation
  Conform a full-term breech presentation26 (40)
  More pro vaginal than full-term breech presentation21 (32)
  More pro cesarean than full-term breech presentation16 (25)
  No answer2 (3)