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Meta-Analysis
. 2012 Oct 17;10(10):CD000051.
doi: 10.1002/14651858.CD000051.pub2.

Cephalic version by postural management for breech presentation

G Justus Hofmeyr  1 , Regina Kulier
Affiliations
Meta-Analysis

Cephalic version by postural management for breech presentation

G Justus Hofmeyr et al. Cochrane Database Syst Rev. .

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 (22 August 2012).

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.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Cephalic version by postural management, Outcome 1 Non‐cephalic births.
1.2
1.2. Analysis
Comparison 1 Cephalic version by postural management, Outcome 2 Caesarean section.
1.3
1.3. Analysis
Comparison 1 Cephalic version by postural management, Outcome 3 Apgar score < 7 at 1 minute.
1.4
1.4. Analysis
Comparison 1 Cephalic version by postural management, Outcome 4 Apgar score < 7 at 5 minutes.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bung 1987 {published data only}
    1. Bung P, Huch R, Huch A. Is Indian version a successful method of lowering the frequency of breech presentations?. Geburtshilfe und Frauenheilkunde 1987;47:202‐5. - PubMed
Chenia 1987 {published data only}
    1. Chenia F, Crowther CA. Does advice to assume the knee‐chest position reduce the incidence of breech presentation at delivery? A randomized clinical trial. Birth 1987;14:75‐8. - PubMed
Founds 2006 {published data only}
    1. Founds SA. Clinical implications from an exploratory study of postural management of breech presentation. Journal of Midwifery & Women's Health 2006;51(4):292‐6. - PMC - PubMed
Hartadottir 1992 {published data only}
    1. Hartadottir H, Thornton JG. A randomised trial of the knee/chest position to encourage spontaneous version of breech pregnancies. Proceedings of 26th British Congress of Obstetrics and Gynaecology; 1992; Manchester, UK, 1992:356. Manchester, 1992:356.
Obwegeser 1999 {published data only}
    1. Obwegeser R, Hohlagschwandtner M, Auerbach L, Schneider B. Management of breech presentation by Indian version ‐ a prospective, randomized trial [Erhohung der Rate von Spontanwendungen bei Beckenendlagen durch die Indische Brucke? Eine prospective, randomisierte Studie]. Zeitschrift fur Geburtshilfe und Neonatologie 1999;203:161‐5. - PubMed
Smith 1999 {published data only}
    1. Smith C, Crowther C, Wilkinson C, Pridmore B, Robinson J. Knee‐chest postural management for breech at term: a randomized controlled trial. Birth 1999;26:71‐5. - PubMed
    1. Smith C, Wilkinson C, Crowther C. Knee chest postural management for breech at term: a randomised controlled trial. 2nd Annual Congress of the Perinatal Society of Australia & New Zealand; 1998 March 30‐April 4; Alice Springs, Australia 1998:143.

References to studies excluded from this review

Bullough 1987 {published data only}
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Cardini 1998 {published data only}
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    1. Drooge PH, Huisjes HJ. Hyperextension treatment in breech presentation [Hyperextensiebehandeling bij stuitligging]. Nederlands Tijdschrift roor Geneeskunde 1984;128:1088‐90. - PubMed

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References to other published versions of this review

Hofmeyr 1995
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