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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.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Cephalic version by moxibustion for breech presentation

There is some evidence to suggest that moxibustion may be useful for turning babies from breech presentation (bottom first) to cephalic presentation (head first) for labour when used with either acupuncture or postural techniques of knee to chest or lifting buttocks while lying on the side.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

External cephalic version for breech presentation before term

Babies born bottom first (in the breech position) may have more problems during birth than those who are born head first (in the cephalic position) because there may be some delay in birth of the head and pressure on the umbilical cord as the head passes through the birth canal. During an external cephalic version (ECV) a breech baby is turned to the head down position by gently pushing on the mother's abdomen. Research shows that ECV after 37 weeks reduces the number of babies in the breech position at full term, and the number of caesarean sections.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery

Does the use of pelvimetry to assess the size of the woman's pelvis improve outcomes for baby and mother? Pelvimetry might identify babies whose heads are too big for their mother's pelvis. In this case, an elective caesarean section might improve the outcome. Forms of pelvimetry include radiological pelvimetry (X‐ray, computerised tomography (CT) scan or magnetic resonance imaging (MRI)) and clinical examination of the woman. We planned to include all studies comparing the use of clinical or radiological (X‐ray, CT or MRI) pelvimetry versus no pelvimetry, or different types of pelvimetry.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Effects of turning unborn babies from bottom first to head first at the end of pregnancy (around 36 weeks or more) for reducing problems during childbirth

The best outcomes in childbirth for both mothers and babies are when the baby is born head‐first. If the baby is in another position, there is a higher risk of complications including the need for caesarean section. In a ‘breech presentation’ the baby is bottom‐down instead of head‐down. External cephalic version (ECV) is a technique for turning the unborn baby so it lies head‐down. This review looked at the effects of using ECV on babies that were in the breech position at the end of pregnancy (around 36 weeks or more).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Mode of delivery in non-cephalic presenting twins: a systematic review

PURPOSE: This systematic review aims to determine if there are evidence-based recommendations for the optimal mode of delivery for non-cephalic presenting first- and/or second twins. We investigated the impact of the mode of delivery on neonatal outcome for twin deliveries with (1) the first twin (twin A) in non-cephalic presentation, (2) the second (twin B) in non-cephalic presentation and (3) both twins in non-cephalic presentation.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Neuraxial blockade for external cephalic version: a systematic review

BACKGROUND: The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review

BACKGROUND: The success rates of external cephalic version (ECV) are improved with the use of betamimetic tocolytics, but these drugs are associated with maternal side effects.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Ways to help turn a breech baby to head first presentation at the end of pregnancy

This review of trials found 28 randomised controlled studies involving 2786 women. Most studies looked at the effects of tocolytic beta stimulant drugs. Results showed that babies are more likely to turn head first during ECV and to remain head first for the start of labour, if women receive beta stimulants. These drugs also reduced the number of caesarean sections, but insufficient data on possible adverse effects were collected. Little information on other types of tocolytic drugs was available, although nitric oxide donors were associated with an increase in headaches. In addition, too little evidence was available to show whether the other ways of trying to help ECV are effective. Further research is needed if we are to increase the success of ECV.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term

This review investigated the frequency of adverse maternal and foetal outcomes associated with external cephalic version in comparison with persisting breech presentation at term. The authors concluded that adverse outcomes are rare though, owing to poor reporting and methodological limitations, there was insufficient evidence to properly quantify adverse maternal and foetal outcomes. The authors' conclusions are appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

External cephalic version-related risks: a meta-analysis

The authors concluded that external cephalic version appeared to be a safe procedure for breech pregnancies and complications were not associated with foetal position post-intervention. Overall, given concerns about the quality of the included studies and the analyses reported, the findings of the review may not be reliable and should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Moxibustion for the correction of nonvertex presentation: a systematic review and meta-analysis of randomized controlled trials

Objectives. This study aims to assess the effectiveness and safety of moxibustion for the correction of nonvertex presentation. Methods. Records without language restrictions were searched up to February 2013 for randomized controlled trials (RCTs) comparing moxibustion with other therapies in women with a singleton nonvertex presentation. Cochrane risk of bias criteria were used to assess the methodological quality of the trials. Results. Seven of 392 potentially relevant studies met the inclusion criteria. When moxibustion was compared with other interventions, a meta-analysis revealed a significant difference in favor of moxibustion on the correction of nonvertex presentation at delivery (risk ratio (RR) 1.29, 95% confidence interval (CI) 1.12 to 1.49, and I (2) = 0). The same findings applied to the cephalic presentation after cessation of treatment (RR 1.36, 95% CI 1.08 to 1.71, and I (2) = 80%). A subgroup analysis that excluded two trials with a high risk of bias also indicated favorable effects (RR 1.63, 95% CI 1.42 to 1.86, and I (2) = 0%). With respect to safety, moxibustion resulted in decreased use of oxytocin. Conclusion. Our systematic review and meta-analysis suggested that moxibustion may be an effective treatment for the correction of nonvertex presentation. Moreover, moxibustion might reduce the need for oxytocin.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Moxibustion for the correction of nonvertex presentation: a systematic review and meta-analysis of randomized controlled trials

Objectives. This study aims to assess the effectiveness and safety of moxibustion for the correction of nonvertex presentation. Methods. Records without language restrictions were searched up to February 2013 for randomized controlled trials (RCTs) comparing moxibustion with other therapies in women with a singleton nonvertex presentation. Cochrane risk of bias criteria were used to assess the methodological quality of the trials. Results. Seven of 392 potentially relevant studies met the inclusion criteria. When moxibustion was compared with other interventions, a meta-analysis revealed a significant difference in favor of moxibustion on the correction of nonvertex presentation at delivery (risk ratio (RR) 1.29, 95% confidence interval (CI) 1.12 to 1.49, and I (2) = 0). The same findings applied to the cephalic presentation after cessation of treatment (RR 1.36, 95% CI 1.08 to 1.71, and I (2) = 80%). A subgroup analysis that excluded two trials with a high risk of bias also indicated favorable effects (RR 1.63, 95% CI 1.42 to 1.86, and I (2) = 0%). With respect to safety, moxibustion resulted in decreased use of oxytocin. Conclusion. Our systematic review and meta-analysis suggested that moxibustion may be an effective treatment for the correction of nonvertex presentation. Moreover, moxibustion might reduce the need for oxytocin.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis

The authors concluded that moxibustion may be more effective than observation or postural methods alone for correcting non-vertex presentation and did not appear to increase complications. The authors suggested the findings should be interpreted cautiously due to heterogeneity between studies. In view of suboptimal study quality and small sample sizes (especially for safety outcomes) such caution is well advised.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Caesarean section for non‐medical reasons at term

Childbirth is a profound and powerful human experience. Women often describe feelings of empowerment, elation and achievement, although other women's experiences include trauma, fear, pain, and loss of control. The way women give birth, either vaginally or by caesarean section, is likely to impact on their feelings. In recent years, caesareans have become safer due to improved anaesthesia and improved surgical techniques, along with the routine use of drugs at surgery to combat the increased risk of infection and blood clots in the mother. However, caesarean section remains a surgical procedure accompanied by abdominal and uterine incisions, scarring and adhesions. There is also evidence of an increased chance of problems in subsequent pregnancies for both women and babies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Planned caesarean section for a twin pregnancy

The incidence of twins varies considerably between communities and families and has recently increased because of the number of older mothers and the use of fertility treatments and assisted conception. Infants from a twin pregnancy are at a higher risk of death around the time of birth than are infants from a singleton pregnancy. Some of this is due to a higher risk of preterm birth. The second‐born twin has an increased risk of a poor perinatal outcome compared with the first‐born twin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Caesarean section versus vaginal delivery for preterm birth for women with a single baby (not multiple birth)

There is not enough evidence to show the effects of a policy of planned immediate caesarean delivery rather than a policy of planned vaginal delivery for the birth of premature babies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Planned caesarean section for term breech delivery

Babies are usually born head first. If the baby is in another position the birth may be complicated. In a ‘breech presentation’ the unborn baby is bottom‐down instead of head‐down. Babies born bottom‐first are more likely to be harmed during a normal (vaginal) birth than those born head‐first. For instance, the baby might not get enough oxygen during the birth. Having a planned caesarean may reduce these problems. We looked at evidence comparing planned caesarean sections and vaginal births at the normal time of birth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Caesarean Section

This guidance is a partial update of NICE clinical guideline 13 (published April 2004) and will replace it.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 2011
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