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Cephalic version by postural management for breech presentationHofmeyr GJ, Kulier R
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SummaryCephalic version by postural management for breech presentationNot enough evidence on encouraging the mother to adopt different postures during pregnancy 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. The review of trials 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 22. 1996 AbstractBackgroundBabies 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. ObjectivesThe objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. Procedures in which the mother rests with her pelvis elevated were evaluated. These include the knee-chest position, and a supine position with the pelvis elevated with a wedge-shaped cushion. Search strategyThe Cochrane Pregnancy and Childbirth Group trials register (searched September 2001) and the Cochrane Controlled Trials Register (Cochrane Library, Issue 3, 2001) were searched. Selection criteriaRandomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group. Data collection and analysisEligibility and trial quality were assessed by one or both reviewers. Main resultsFive studies involving a total of 392 women were included. No effect of postural management on the rate non-cephalic births was detected, either for the subgroup in which no external cephalic version was attempted, or for the group overall (relative risk 0.95, 95% confidence interval 0.81 to 1.11). No differences were detected for caesarean sections or Apgar scores below seven at one minute. Authors' conclusionsThere 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. |