Maternal body mass index and external cephalic version success rate — are they related?
, 1, 2, 1, 1
Abstract
Objectives: External cephalic version (ECV) is a useful method helping to reduce the incidence of planned caesarean deliveries for fetal malpresentation. There is an effort to look for the best predictors for a successful ECV, the effect of maternal weight is still unclear. The aim of our study is to determine maternal body mass index (BMI) in association with the ECV success rate and the risk of complications.
Material and methods: A retrospective observational cohort study in 981 women after the 36th week of gestation with a fetus in a breech presentation who had undergone an ECV attempt. We evaluated the success rate and complications of ECV in association with BMI categories according to the WHO classification of obesity.
Results: ECV was successful in 478 cases (48.7%). In the category of overweight patients (BMI > 25; n = 484), ECV was successful in 51% and unsuccessful in 49% (p = 0.28) of cases. In obese patients (BMI > 30; n = 187), ECV was successful in 44.8% and unsuccessful in 55.2% (p = 0.28) of cases. The effect of BMI on the success rate of ECV for the category of overweight and obesity was not proven by statistical analysis. Serious complications occurred in seven cases in similar numbers in all three subgroups according to BMI.
Conclusions: BMI in the categories of overweight and obesity is not a factor influencing the success rate and risk of complications of ECV. These results can be helpful when consulting pregnant women the chance of successful ECV.
Keywords: external versionbreech presentationpregnancymaternal obesitybody mass index
References
- External Cephalic Version and Reducing the Incidence of Term Breech Presentation: Green-top Guideline No. 20a. BJOG. 2017; 124(7): e178–e192.
- Breech presentation: South Australian Perinatal Practice Guideline n.d.:13. https://www.sahealth.sa.gov.au/wps/wcm/connect/2277f4804ee1e4adae3aafd150ce4f37/Breech+presentation_June2014.pdf?MOD=AJPERES&CACHEID=2277f4804ee1e4adae3aafd150ce4f37.
- Hruban L, Janků P, Jordánová K, et al. [External cephalic version of breech fetus after 36 weeks of gestation - evaluation of efectiveness and complications]. Ceska Gynekol. 2017; 82(6): 443–449.
- Wágnerová K, Hruban L, Janků P. External cephalic version after 36th week of gestation - Analysis of women´s perspective. Ceska Gynekol. 2017; 82: 355–361.
- Ciliacus E, van der Zalm M, Truijens SE, et al. Fear for external cephalic version and depression: predictors of successful external cephalic version for breech presentation at term? BMC Pregnancy Childbirth. 2014; 14: 101.
- Kok M, Cnossen J, Gravendeel L, et al. Clinical factors to predict the outcome of external cephalic version: a metaanalysis. Am J Obstet Gynecol. 2008; 199(6): 630.e1–7; discussion e1.
- Salzer L, Nagar R, Chen R, et al. 583: Predictors of successful external cephalic version and assessment of success for vaginal delivery. Am J Obstet Gynecol. 2014; 210(1): S287–S288.
- Indraccolo U, Graziani C, Di Iorio R, et al. External cephalic version for singleton breech presentation: proposal of a practical check-list for obstetricians. Eur Rev Med Pharmacol Sci. 2015; 19(13): 2340–2353.
- Cho LY, Lau WL, Lo TK, et al. Predictors of successful outcomes after external cephalic version in singleton term breech pregnancies: a nine-year historical cohort study. Hong Kong Med J. 2012; 18(1): 11–19.
- Ebner F, Friedl TWP, Leinert E, et al. Predictors for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet. 2016; 293(4): 749–755.
- Limaye M, Abdullahi N, Has P, et al. Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term. AJP Rep. 2019; 9(4): e323–e327.
- Velzel J, de Hundt M, Mulder FM, et al. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2015; 195: 160–167.
- Lim PS, Ng BK, Ali A, et al. Successful external cephalic version: factors predicting vaginal birth. ScientificWorldJournal. 2014; 2014: 860107.
- Zandstra H, Mertens HJ. Improving external cephalic version for foetal breech presentation. Facts Views Vis Obgyn. 2013; 5(2): 85–90.
- Chaudhary S, Contag S, Yao R. 862: External cephalic version and complication rates according to maternal body mass index. Am J Obstet Gynecol. 2017; 216(1): S493.
- Ayres-de-Campos D. Obesity and the challenges of caesarean delivery: prevention and management of wound complications. Best Pract Res Clin Obstet Gynaecol. 2015; 29(3): 406–414.
- Vegel AJ, Benden DM, Borgert AJ, et al. Impact of Obesity on Cesarean Delivery Outcomes. WMJ. 2017; 116(4): 206–209.
- Binder T, Unzeitig V, Velebil P. Vedení prenatální péče a porodu donošeného plodu v poloze koncem pánevním - doporučený postup n.d.:2. http://www.lekaridnes.cz/wp-content/uploads/2016/08/p-2013-vedeni-prenatalni-pece-a-porodu-donoseneho-plodu-v-poloze-koncem-panevnim.pdf.
- Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Erlbaum Associates, Hillsdale 1988.
- Borenstein M. Introduction to meta-analysis. John Wiley & Sons, Chichester 2009.
- Chaudhary S, Contag S, Yao R. The impact of maternal body mass index on external cephalic version success. J Matern Fetal Neonatal Med. 2019; 32(13): 2159–2165.
- Holman M, Ainsworth A, Weaver A, et al. Does Maternal Body Mass Index or Weight Gain Affect External Cephalic Version Success? [19H]. Obstetrics & Gynecology. 2016; 127(Supplement 1).
- Mowat A, Gardener G. Predictors of successful external cephalic version in an Australian maternity hospital. Aust N Z J Obstet Gynaecol. 2014; 54(1): 59–63.
- Morgan ER, Hu AE, Brezak AMV, et al. Predictors of a successful external cephalic version: A population-based study of Washington state births. Women Birth. 2019; 32(3): e421–e426.
- Averett SL, Fletcher EK. Prepregnancy Obesity and Birth Outcomes. Matern Child Health J. 2016; 20(3): 655–664.
- Zhao R, Xu L, Wu ML, et al. Maternal pre-pregnancy body mass index, gestational weight gain influence birth weight. Women Birth. 2018; 31(1): e20–e25.
- Alves P, Malheiro MF, Gomes JC, et al. Risks of Maternal Obesity in Pregnancy: A Case-control Study in a Portuguese Obstetrical Population. Rev Bras Ginecol Obstet. 2019; 41(12): 682–687.
- Jura M, Kozak LP. Obesity and related consequences to ageing. Age (Dordr). 2016; 38(1): 23.
- Veghari G. Maternal age and BMI in relation to infant birth size: a study in public health centers in the north of Iran. Int J Med Res Health Sci. 2016; 5(9): 151–155.
- Vinayagam D, Chandraharan E. The adverse impact of maternal obesity on intrapartum and perinatal outcomes. ISRN Obstet Gynecol. 2012; 2012: 939762.
