Manipulative Reduction for Abnormal Uterine Inclination in Vaginal Delivery.

OBJECTIVE: To investigate the manipulative reduction in abnormal uterine inclination in vaginal delivery. METHODS: With the independently developed uterine inclination surveyor, 40 primiparas with abnormal uterine inclination were randomly divided into two groups: treatment group (Group A, 20 cases) and control group (Group B, 20 cases). The general condition of the primipara, the labor stages, the changes in uterine inclination after treatment, postpartum hemorrhage at 2 hours, and the general condition of fetuses were observed to study the therapeutic value of manual reduction in abnormal uterine inclination. RESULT: In the control group, one uterine inclination was not corrected with the change in labor process, and the pregnancy was terminated due to stagnation of the active phase. In the first stage of labor, the time spent in the treatment group (393.4 ± 31.3 mins) was significantly lower than that in the control group (440.7 ± 34.9 mins) (P = 0.001). Compared with the control group (49.8 ± 6.5 mins), the treatment group (42.6 ± 7.2 mins) also exhibited a significantly shortened second stage of labor (P = 0.02). Sixteen cases (16/20) in the treatment group returned to normal after manual reduction, and 9 cases (9/20) in the control group returned to normal with the progression of natural labor. Manual reduction could be used as an option to treat abnormal uterine inclination (P = 0.01). There was no significant difference in the third stage of labor (P = 0.2), 2-hour postpartum hemorrhage (P = 0.35), Apgar score (P = 0.64), or body weight (P = 0.76) between the two groups. CONCLUSION: Manual reduction in the treatment of abnormal uterine inclination has obvious effects, shortens the birth process, and is safe for the fetus.

Rebozo and External Cephalic Version in breech presentation (RECEIVE): A randomised controlled study.

OBJECTIVE: To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth. DESIGN: A multicentre randomised controlled trial. SETTING: Three university hospitals in Copenhagen, Denmark. POPULATION: Pregnant women with a breech or transverse presentation at 35 weeks or more of gestation eligible for ECV. METHODS: We compared rebozo before ECV with ECV alone. The randomisation was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3-5 days before the scheduled ECV. Analyses were by intention-to-treat. MAIN OUTCOME MEASURE: The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n = 187) or control (n = 185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention. CONCLUSIONS: In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth. TWEETABLE ABSTRACT: Home-based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth.

Effectiveness of Moxibustion for Breech Presentation: A Prospective Study.

OBJECTIVE: To evaluate the moxibustion for turning fetuses from breech to vertex presentation. MATERIALS AND METHODS: This was a single-center prospective study. All pregnant women carrying a fetus in breech presentation between the 32 and 35 gestational weeks were offered moxibustion application. The primary outcomes were vertex presentation at 37 weeks of gestation, vertex presentation at birth, and vaginal birth rates. A secondary analysis was performed to understand the effect of parity, type of breech presentation, body mass index (BMI), placental location, gender, and fetal birth weight on the presentation at birth. RESULTS: There were 63 cases in the study group and 245 cases in the control group. The rate of vertex presentation at term was found to be higher in the moxibustion group compared to controls (66.7 vs. 48.2%, p=0.022). There were 45 (71.4%) and 131 (53.5%) fetuses with vertex presentation at birth in the study and control groups, respectively (p=0.020). Overall, vaginal delivery rate was higher in the study group (50.8 vs. 37.1%, p=0.048). Multiparity and higher birth weight were associated with increased rates of vertex presentation in the moxibustion and control groups. CONCLUSION: Moxibustion application increased the rate of vertex presentation at birth and also vaginal delivery rate compared with expectant management. Offering moxibustion between the 32nd and 36th week of gestation may provide women with a singleton fetus in breech presentation an opportunity for a vaginal birth.

Digital and Manual Rotation of the Persistent Occiput Posterior Fetus.

Persistent fetal occiput posterior (OP) position is a topic of interest with implications for intrapartum management. Although studies report a low incidence of persistent OP position, anecdotal evidence suggests an increase in prevalence given changes in maternal demographics. Clinicians are often familiar with interventions such as position changes and the use of props and a rebozo to address persistent OP position in early labor; however, midwives remain uncomfortable with the techniques of digital and manual rotation. This article reviews current evidence and recommendations for the management of persistent OP position in the second stage of labor. Further research is needed to guide clinicians on the optimal timing and techniques for digital and manual rotation.

[Breech Presentation: CNGOF Guidelines for Clinical Practice - External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation]. / Présentation du siège. Recommandations pour la pratique clinique du CNGOF ­ Version par manœuvre externe et techniques de version alternatives.

OBJECTIVES: To provide guidelines regarding efficiency and safety of external cephalic version (ECV) attempt and alternatives methods to turn breech babies to cephalic presentation. METHODS: MedLine and Cochrane Library databases search in French and English and review of the main foreign guidelines between 1980 and 2019. RESULTS: ECV is associated with a decreasing rate of breech presentation at birth (LE2), and potentially with a lower rate of cesarean section (LE3) without an increase of severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV should be attempt (Professional consensus). ECV attempt should be performed with immediate access to an operating room for emergency cesarean (Professional consensus). The ECV attempt before 37 weeks, compared to ECV attempt after 37 weeks, increases the rate of cephalic presentation at birth (LE2) but with a small increase risk of moderate prematurity (LE2). ECV attempt should be performed from 36SA (Professional consensus). The main factors associated with successful ECV attempt are multiparity (LE3) and no maternal obesity (LE3). Parenteral tocolysis (ß mimetic or atosiban), for ECV attempt at term is associated with a higher success rate (LE2), higher rate of achieved cephalic presentation in labor (LE2) and a lower cesarean section rate (LE2). It is recommended to use parenteral tocolysis for ECV attempt at term in order to increase its success rate (grade B). The ECV attempt is associated with an increase in transient FHR abnormalities (LE3), it is therefore recommended that cardiotocography should be performed prior and during 30minutes after the procedure (Professional consensus). There is no argument for recommending the practice of delayed cardiotocography after ECV attempt (Professional consensus). The risk of significant positivity (>30mL) of the Kleihauer test after ECV attempt is low (<0.1%) (LE3), it is not recommended to systematically perform a Kleihauer test after ECV attempt (professional consensus). In case of RH-1 negative women, it is recommended to ensure systematic RH-1 prophylaxis (Professional consensus). In case of breech presentation at term, acupuncture, moxibustion and postural methods are not effective in reducing breech presentation at birth (LE2), and are therefore not recommended (Grade B). CONCLUSION: According to the clear benefits and the low risks of ECV attempt, all women with a breech presentation at term should be informed that ECV should be attempted to decrease breech presentation at birth and cesarean section.

Global competencies for midwives: external cephalic version; ultrasonography, and tobacco cessation intervention.

PROBLEM AND BACKGROUND: The International Confederation of Midwives (ICM) conducts regular updates to the Essential Competencies for Basic Midwifery Practice to determine the introduction or retention of items in the global scope of midwifery practice guidance document. AIM: This article presents the review process that underpinned the deliberation about three specific clinical practices: external cephalic version, prenatal ultrasonography, and tobacco cessation interventions that occurred during the 2016-2017 global update study. METHODS: A brief outline of the research methodology used in the 2016-2017 study is provided. Literature summaries about safety and effectiveness of three clinical skills are offered. Data addressing global and regional variations in support of each practice and final disposition of the items are documented. FINDINGS: External cephalic version did not receive sufficient document support for inclusion in the initial list of items to be tested in the study. Prenatal ultrasonography was supported as an advanced (76.6%) or country-specific (18.8%) skill that midwives could acquire, to promote wider global access for pregnant women. Midwives' participation in tobacco cessation counselling was supported (≥85%) in each of ICM's regions. Knowledge about World Health Organization recommendations for nicotine replacement therapy was endorsed as an additional (62.4%) or country-specific (29.3%) skill. DISCUSSION AND CONCLUSION: The current evidence of safety of midwives performing external cephalic version led to the recommendation that it be considered in the next document update. Conflicting views of midwives' role in acquiring skills to conduct prenatal ultrasound were evident. There was strong support for participation in smoking cessation counselling, but knowledge of World Health Organization recommendations was not highly endorsed.

Moxibustion for Cephalic Version of Breech Presentation.

Moxibustion, a form of traditional Chinese medicine (TCM), is the burning of the herb moxa (Folium Artemisiae argyi or mugwort) over acupuncture points. It is often used in China to facilitate cephalic version of breech presentation. This article reviews the history, philosophy, therapeutic use, possible mechanisms of action, and literature pertaining to its use for this indication. For moxibustion, moxa can be rolled into stick form, placed directly on the skin, or placed on an acupuncture needle and ignited to warm acupuncture points. Studies have demonstrated that moxibustion may promote cephalic version of breech presentation and may facilitate external cephalic version. However, there is currently a paucity of research on the effects of moxibustion on cephalic version of breech presentation, and thus there is a need for further studies. Areas needing more investigation include efficacy, safety, optimal technique, and best protocol for cephalic version of breech presentation.

Cuidados de la matrona en la versión cefálica externa / Midwife care in external cephalic version

La versión cefálica externa (VCE) es una maniobra obstétrica que intenta convertir una presentación fetal podálica o transversa en cefálica, más favorable de cara al parto. La matrona, como parte del equipo multidisciplinar, está presente durante el proceso de su realización, aplicando los cuidados necesarios para una atención integral de la mujer gestante. El objetivo de este artículo es presentar el caso clínico de una mujer embarazada durante el procedimiento de VCE. Se elabora el plan de cuidados enfermeros basado en las necesidades básicas de Virginia Henderson y guiado por la taxonomía NANDA-NIC-NOC, donde se identifican tres diagnósticos de Enfermería, que serán la base de la realización de este proceso enfermero: temor, dolor agudo y riesgo de alteración de la díada materno/fetal. La aplicación de este plan de cuidados supuso una mejora en la atención a la mujer y en la organización del trabajo

External cephalic version (ECV) is an obstetric manoeuvre intended to change a breech or transversal fetal presentation into cephalic, more favourable in terms of delivery. The midwife, as a member of the multidisciplinary team, will be present during this procedure, implementing any necessary measures for a comprehensive care of the pregnant woman. The objective of this article is to present the clinical case of a pregnant woman during the ECV procedure. The nursing care plan is prepared on the basis of Virginia Henderson’s basic needs, and guided by the NANDA-NIC-NOC taxonomy, where three nursing diagnoses will be identified as the basis for conducting this nursing process: fear, acute pain and risk of alteration of the maternal/fetal dyad. The application of this healthcare plan represented an improvement in women care and work organization

Uso da moxabustão e acupuntura em gestantes com Apresentação pélvica: revisão integrativa / Use of moxibustion and acupuncture in pregnant women with breech presentation: an integrative review / Uso de la moxibustión y acupuntura en embarazadas con presentación de nalgas: revisión integrador

O objetivo deste estudo foi conduzir uma revisão integrativa a fim de identificar publicações sobre a moxabustão e acupuntura para versão de fetos em apresentação pélvica. A ferramenta de pesquisa Paciente, Intervenção, Comparação e Desfecho, disponibilizada pela base de dados da Biblioteca Nacional de Medicina dos Estados Unidos, foi utilizada para gerar uma lista de artigos. As palavras utilizadas para a busca foram os termos breech, moxibustion, acupuncture e cephalic. A busca foi realizada no mês de março de 2016. Foram encontrados 24 registros, 18 foram analisados, dentre os quais sete foram favoráveis ao uso da moxabustão, e cinco, desfavoráveis. A partir dos estudos realizados sobre o tema, há evidências de que a moxabustão seja segura e efetiva para tentar "corrigir" apresentações pélvicas, apresentando-se como uma ferramenta no complemento da assistência prestada por profissionais na área da obstetrícia (AU).

The objective in this study was to develop an integrative review to identify publications on moxibustion and acupuncture to turn fetuses in breech position. The research tool Patient, Intervention, Comparison and Outcome, available through the database of the United States National Library of Medicine, was used to produce a list of articles. The words used for the search were: breech, moxibustion, acupuncture and cephalic. The search was undertaken in March 2016. Twenty-four registers were found, 18 of which were analyzed, seven of them favorable to the use of moxibustion and five unfavorable. Based on the studies developed on the theme, there is evidence that moxibustion is safe and effective to try and "correct" breech presentations, as a tool to complement the care midwifery professionals provide (AU).

El objetivo de este estudio fue desarrollar una revisión integradora para identificar publicaciones sobre la moxibustión y acupuntura para versión de fetos en presentación de nalgas. La herramienta de investigación Paciente, Intervención, Comparación y Desfecho, publicada por la base de datos de la Biblioteca Nacional de Medicina de Estados Unidos, fue utilizada para generar un rol de artículos. Las palabras utilizadas para la búsqueda fueron: breech, moxibustion, acupuncture y cephalic. La búsqueda fue llevada a cabo en marzo del 2016. Fueron encontrados 24 registros, 18 fueron analizados, entre los cuales siete fueron favorables al uso de la moxibustión y cinco desfavorables. A partir de los estudios desarrollados sobre el tema, hay evidencias de que la moxibustión sea segura y efectiva para intentar "corregir" presentaciones de nalgas, siendo una herramienta para complementar la atención prestada por profesionales en el área de partería (AU).

Evaluación de la eficacia de la aplicación de la moxibustión en presentaciones no cefálicas en gestantes asistidas en atención primaria / Evaluation of the effectiveness of the moxibustion in non-cephalic presentations in pregnant women assisted in Primary Care

OBJETIVO: Evaluar la eficacia de la moxibustión, combinada con la posición genupectoral, para versionar fetos en presentaciones no cefálicas a cefálica, durante el tercer trimestre de gestación. Como objetivos secundarios se planteó evaluar la seguridad de la técnica de moxibustión e identificar el tipo de parto, las semanas de gestación (SG) y el peso del recién nacido. MATERIAL Y MÉTODOS: Ensayo clínico aleatorizado, controlado y multicéntrico, realizado en consultas de 9 centros de atención a la salud sexual y reproductiva de la comarca del Baix Llobregat (Barcelona). La selección de gestantes se hizo tras la ecografía del tercer trimestre. Si se observaba una presentación no cefálica, se invitaba a las gestantes a participar. Tras firmar el consentimiento, se procedía a la asignación aleatoria a un grupo de intervención (GI) o a un grupo control (GC). El GI recibió 1 semana de tratamiento con moxibustión en el punto BL67 y posición genupectoral. El GC recibió tratamiento con moxibustión en un punto neutro y posición genupectoral. Las participantes recibieron las explicaciones necesarias para la aplicación de la técnica 2 veces al día durante 1 semana. RESULTADOS: Participaron 88 gestantes entre las 32 y 36 SG. Hubo 47 gestantes en el GI y 41 en el GC, con características similares al inicio del estudio. El número de sesiones aplicadas fue similar en ambos grupos, sin complicaciones. El 44,7% de los partos del GI fueron en presentación cefálica, frente al 43,9% del GC (p= 0,6). El número de partos vaginales en el GI fue de 18 (38,3%), frente a 13 (31,7%) en el GC (p= 0,3). No se observaron diferencias en las SG en el momento del parto ni en el peso de los recién nacidos. CONCLUSIONES: El uso de la moxibustión aplicada durante 7 días en el punto BL67 junto con la posición genupectoral entre las 32 y 36 SG no demostró en este estudio un aumento de las versiones de fetos en posiciones anómalas a cefálica. La técnica no presentó complicaciones

AIM: To evaluate moxibustion efficacy, combined with knee-chest position, for foetus version from no cephalic presentation to cephalic presentation during the 3rd trimester of gestation. To evaluate the security of the moxibustion technique and to identify type of delivery, weeks of gestation and the weight of the newborn. Subjects, material and methods: Multicenter, randomized, controlled trial conducted in 9 primary care centres focused on sexual and reproductive health of the Baix Llobregat (Barcelona) region. Selection was done after the 3rd trimester ultrasound scan. When a non-cephalic presentation was found, women were asked to join the study. After signing the informed consent, random allocation took place and they were divided into intervention group (IG) and control group (CG). IG received a one week treatment with moxibustion at point BL67 combined with knee-chest position. CG received moxibustion treatment at a neutral point combined with knee-chest position too. For both groups they were given the necessary explanations for a correct application twice a day during a week. RESULTS: A total 88 pregnant women between 32-36 weeks of gestation were studied, 47 pregnant mothers enrolled in IG and 41 in CG, with similar characteristics at the beginning of the study. Number of performed sessions was similar for both groups and without complications

Acupuncture version of breech presentation: a randomized sham-controlled single-blinded trial.

BACKGROUND: Several studies have investigated the efficacy of moxibustion with or without acupuncture for fetal version, but the results are discordant. Meta-analyses pointed out the need for robust, methodologically sound, randomized controlled trials. OBJECTIVE: The objective of this study was to assess the effectiveness of acupuncture with fire needling on acupoint BL67 for version of breech presentation. STUDY DESIGN: This was a randomized, sham-controlled, single-blinded trial, which took place in Strasbourg teaching maternity hospital, France. A total of 259 patients between 32 and 34 weeks of gestation have been randomized and analyzed. Patients were randomized to either acupuncture with fire needling or sham group, and were analyzed in their initial allocation group. Statistical analysis was conducted using Bayesian methods, in univariate analysis and in multivariate analysis after adjustment on parity. RESULTS: The primary outcome was the rate of cephalic presentations at ultrasound examination performed between 35 and 36 weeks of gestation. A total of 49 (37.7%) fetuses were in cephalic presentation in the acupuncture group, versus 37 (28.7%) in the sham group: RR 1.34 [0.93-1.89], Pr RR>1=94.3%. After adjustment on parity, the acupuncture did not increase the rate of fetal cephalic version: OR 1.47 [0.84-2.42], Pr OR>1=90.3%. CONCLUSIONS: Our study suggests that acupuncture with fire needling on acupoint BL67 does not promote fetal cephalic version. Further studies might investigate effectiveness of other protocols of acupuncture. Randomization should be stratified for nulliparous and parous patients.

Moxibustion did not have an effect in a randomised clinical trial for version of breech position.

INTRODUCTION: In Chinese traditional medicine, the stimulation of acupuncture point no. 67 - the bladder meridian - is recommended to favour cephalic version in case of foetal breech presentation. The point can be stimulated by an acupuncture needle, ginger application, fingertip pressure, laser or moxibustion; moxibustion is heat generated by a burning stick containing the herb Artemisia vulgaris. A Cochrane review concluded that more research on the effectiveness of moxibustion is needed. This study aimed to estimate the effectiveness of moxibustion for version of breech presentation. METHODS: We included 200 women in gestational week 33 who had a singleton foetus in breech position. They were randomised to moxibustion treatment daily for two weeks or control without moxibustion. The randomisation was performed for nulliparous and parous women separately. RESULTS: After the trial, which lasted on average 16 days, the breech position was confirmed in 68 of the 92 nulliparous and in 50 of the 108 parous women (74% versus 46%, p < 0.01); furthermore, cephalic position was verified in 76 women and other positions in six women. No significant difference regarding the incidence of breech position was found in the moxibustion group compared with the control group (risk ratio (RR) = 1.05, 95% confidence interval (CI): 0.8-1.38); nor in nulliparous (RR = 1.17, 95% CI: 0.77-1.76) or in parous women (RR = 1.0, 95% CI: 0.69-1.46); an RR > 1 favours moxibustion). CONCLUSIONS: No significant effects of moxibustion were found in correcting the breech position in primiparous and parous women after their 33rd gestational week. FUNDING: none. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov as NCT02251886.

Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.

BACKGROUND: Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth. METHODS: A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically. RESULTS: Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper. CONCLUSIONS: In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way.

An observational study of the success and complications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwives.

OBJECTIVE: To evaluate the success of an external cephalic version (ECV) training programme, and to determine the rates of successful ECV, complications, and caesarean birth in a low-risk population. DESIGN: Prospective observational study. SETTING: Primary health care and hospital settings throughout the Netherlands (January 2008-September 2011). POPULATION: Low-risk women with a singleton fetus in breech presentation, without contraindications to ECV, were offered ECV at approximately 36 weeks of gestation. METHODS: Data were collected for all ECVs performed by midwives, and were entered into a national online database. MAIN MEASURES: Successful ECV was defined as the fetus having a cephalic presentation immediately following the procedure and at birth. Complications were observed at ≤ 30 minutes and between 30 minutes and 48 hours after the ECV procedure. All serious pregnancy outcomes that occurred after the ECV procedure until birth were reported. RESULTS: A total of 47% had a successful ECv and a cephalic at the time of birth: 34% of nulliparous and 66% of multiparous women. After ECV, 57% of women gave birth vaginally: 45% of nulliparous women and 76% of multiparous women. Within 30 minutes after ECV, and between 30 minutes and 48 hours after ECV, the proportion of women experiencing a complication or serious pregnancy outcome was 0.9% and 1.8%, respectively. Serious pregnancy outcome at any time following ECV until birth was experienced by 58 (2.5%) of the women. CONCLUSIONS: The success rate of ECVs performed by trained midwives in primary health care or hospital settings is comparable with that of other providers, and the procedure is safe for low-risk women.