Buskens E, Van Oirschot C, Bruinse HW; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2000; 16: 263.
Julius Center for Patient Oriented Research , Utrecht, The Netherlands
Breech presentation is associated with increased risk of adverse outcome for both fetus and mother and frequently calls for a caesarean. However, this procedure is best avoided as it is not without complications either. Giving birth the natural way is preferred by far indicating cephalic version. Yet, this procedure again is not without risk and frequently fails, especially in nulliparous. The current study was undertaken to develop an accurate clinical prediction rule for decision support. A cohort of 190 consecutive women (100 nulliparae and 90 multiparae) presenting with singleton breech presentation at term at St Elizabeth Hospital, Tilburg, the Netherlands, from January 1993 until 1996 agreed to participate and were enrolled in the study. Baseline characteristics such as: parity, type of breech, placenta location, fetal position, amount of amniotic fluid and engagement of the breech were recorded. Subsequently, cephalic version under tocolysis was attempted and the outcome recorded. A second consecutive cohort of 78 women (48 nuliparae and 28 multiparae) underwent external cephalic version at UMCU in 1997 and 1998. The same data were recorded. While data were gathered the results were not known to the obstetricians performing the procedures. The first cohort served as a derivation set, the second for validation. In the analysis, first, Chi-square tests were used to select subclasses of the variables with similar association with successful outcome. Subclasses with similar association were combined yielding dichotomised variables. Subsequently, a multivariate logistic regression model predicting successful version was derived. Beta-coefficients were used to derive independent score values for a clinical prediction rule, the latter validated in the second cohort. In the derivation cohort version was succesful in 43%, i.e., 28% in nulliparae and 59% in muliparae. For multiparae,regardless of clinical characteristics successful version occurred in over 36%. Accordingly, the prediction rule was derived for nulliparae only and included placenta location, fetal position and type of breech, with score values of 1, 2 and 1 respectively. At a cut-off of 2 score points success was predicted correctly in 31% and failure in 93%. In the validation cohort a 46% succes rate was achieved, i.e., 33% in nulliparae and 71% in multiparae. The prediction rule would have correctly predicted success in 39% and failure in 100%. No serious complications occurred. Neonates and mothers were discharged well. In conclusion the scoring system developed may support clinical decision making with regard external cephalic version in nulliparae. In multiparae the likelihood of success is considerable regardless of the clinical characteristics and cephalic version may be attempted unless specific contra-indications are present.
Publication Types:
Keywords:
- Amniotic Fluid
- Breech Presentation
- Female
- Fetus
- Humans
- Infant, Newborn
- Labor Presentation
- Netherlands
- Parity
- Pregnancy
- Tocolysis
- Version, Fetal
- surgery
- hsrmtgs
Other ID:
UI: 102271721
From Meeting Abstracts