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Cephalic version by postural management for breech presentation

  • Review
  • Intervention

Authors

  • G Justus Hofmeyr,

    Corresponding author
    1. University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa
    • G Justus Hofmeyr, Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, 5200, South Africa. justhof@gmail.com.

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  • Regina Kulier

    1. World Health Organization, Geneva, Switzerland
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Abstract

Background

Babies with breech presentation (bottom first) are at increased risk of complications during birth, and are often delivered by caesarean section. The chance of breech presentation persisting at the time of delivery, and the risk of caesarean section, can be reduced by external cephalic version (ECV - turning the baby by manual manipulation through the mother's abdomen). It is also possible that maternal posture may influence fetal position. Many postural techniques have been used to promote cephalic version.

Objectives

The objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. We evaluated procedures in which the mother rests with her pelvis elevated. These include the knee-chest position, and a supine position with the pelvis elevated with a wedge-shaped cushion.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 September 2010).

Selection criteria

Randomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group.

Data collection and analysis

One or both review authors assessed eligibility and trial quality.

Main results

We have included six studies involving a total of 417 women. The rates for non-cephalic births, Cesarean section and Apgar scores below 7 at one minute, regardless of whether ECV was attempted or not, were similar between the intervention and control groups (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.84 to 1.15; RR 1.10; 95% CI 0.89 to 1.37; RR 0.88; 95% CI 0.50 to 1.55).

Authors' conclusions

There is insufficient evidence from well-controlled trials to support the use of postural management for breech presentation. The numbers of women studied to date remain relatively small. Further research is needed.

Plain language summary

Cephalic version by postural management for breech presentation

There is currently not enough evidence for encouraging the mother to adopt different postures during pregnancy in order to change a breech baby's position in the womb.

Babies born in the breech position (bottom first) are more likely to have problems during birth than babies born head first (cephalic). There are different ways of trying to encourage the baby to turn so that he/she can be born head first. Some of these involve the mother adopting different postures. This review of six trials, involving 417 women, found too little evidence to support the use of certain postures to change the baby's position in pregnancy to head down. Further research is required.

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