North West London Hospitals NHS Trust

1. North West London Hospitals NHS Trust Is there an increased risk of meconium after External Cephalic Version? Ilka Tan, HiranSamarage Department of Obstetrics & Gynaecology, North West London HospitalsNHS Trust, London, United Kingdom INTRODUCTION Vaginal delivery is associated with increased neonatal early morbidity and mortality compared with elective Caesarean section for breech presentation at term. External cephalic version (ECV) is advocated in breech presentation at term to facilitate safe vaginal delivery. ECV is generally accepted as safe although immediate emergency Caesarean Section rate is thought to be around 0.5% 1. We conducted a study to compare complication rates following unsuccessful and successful ECV. METHODS A retrospective cohort study was conducted in a large London district general hospital. All ECVs in pregnancies delivering between 01 January 2006 and 31 December 2011 were analysed. The data was extracted from Ciconia Maternity Information System (CMiS) and entered into Microsoft Excel for statistical analysis. Further statistical analysis was calculated using simple interactive statistical analysis. Figure 1. Infant outcomes of unsuccessful and successful ECV RESULTS In the 6 year period, 140 ECV were performed. Of these 140 ECV, 37 were successful giving an overall success rate of 26.4%. (figure 1). There were no significant differences between unsuccessful and successful ECV in blood loss at delivery, Apgarscores at 1 and 5 minutes. However, women who have an unsuccessful ECV were likely to deliver earlier, less likely to have meconiumat delivery, and have an infant that weighs less (table 1). However, there was no difference in the gestational birthweight quartiles between the 2 groups. Fifteen cases had meconium at delivery, of which 4 had an unsuccessful ECV and 11 had a successful ECV. When the data analysis was restricted to deliveries between 37+0 to 40+0 weeks gestation, 3 of 91 (33.0%) unsuccessful ECV had meconium, in contrast to 6 of 16 (37.5%) successful ECV (figure 2). This difference remains statistically significant (p<0.001). Table 1. Infant outcomes of unsuccessful and successful ECV CONCLUSIONS Although earlier delivery in the unsuccessful ECV can be accounted for by elective Caesarean section at 39 weeks rather than awaiting spontaneous onset of labour, the higher incidence of meconium in successful ECV is not explained by post-maturity. It is uncertain if successful ECV were the result of more forceful manipulation which may be more distressing for the fetus within during the procedure. This may be an important factor in counseling and managing labour of successful ECV. Larger studies assessing the risks of meconium aspiration and complications are warranted. Correspondence:ilka.tan@nhs.net Figure 2. Risk of meconium stained liquor at delivery for pregnancies with unsuccessful and successful ECV. References 1: Royal College of Obstetricians and Gynaecologists. The management of breech presentation. Green-top Guideline No. 20b. London: RCOG; 2006. 2: Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of breech presentation. Green-top Guideline No. 20a. London: RCOG; 2010.