Dissertations / Theses on the topic 'Breech presentation'

The Breech Baby Study is a mixed methods study which combines qualitative and quantitative inquiry. This study explores psycho-social-cultural risk factors for breech presentation from an evolutionary perspective. The quantitative component of the study uses Florida birth certificate and Medicaid data sets from 1992-2003 to evaluate the influence of ethnicity and socio-economic status on breech presentation. Ethnicity and socio-economic status account for less than two percent of the variance of risk factors for breech presentation. The qualitative study includes 114 mothers of breech and cephalic presentation babies who completed the State Trait Personality Inventory and a socio-demographic survey. Of these, 52 mothers of cephalic presentation babies and 23 mothers of breech presentation also participated in an in-depth interview about formative life experiences and peri-conception through delivery. The primary data analysis found mothers of breech presentation babies exhibit psycho-social-cultural characteristics unlike those found in mothers of cephalic presentation babies. These characteristics include being idealistic, analytical, polished, overextended, and fearful. Mothers of cephalic presentation babies were better equipped to adapt to unexpected situations and to be pragmatic in the face of unresolvable circumstances. Mothers of breech presentation babies were further separated into two categories. One category is achievement focused woman while the other is non-present focused woman. While both sets of breech presentation mothers were idealistic, the achievement focused mothers were more likely to be analytical, polished, and overextended. In contrast, the non-present focused mothers had a history of abuse and were more likely to have an unresolved pregnancy outcome or to be fearful. Breech presentation is interpreted by attachment theory, evolutionary ecological reproductive theory, and developmental plasticity theory as a fetal strategy to adapt to the intra-uterine relationship environment and an attempt to predict the extra-uterine relationship environment.

Includes bibliographical references.
Background External Cephalic Version (ECV) is the manipulation of the baby, through the mother’s abdomen to a cephalic presentation. ECV is typically performed antenatally, in women with a breech presentation who are not in labour, at or near term, to improve their chances of having a normal vaginal delivery. ECV is one of the few obstetric interventions for which there is evidence that its use leads to a fall in caesarean section rates. ECV is an intervention that gives women another option, prior to considering caesarean section. Objective: To evaluate whether there were missed opportunities for performing ECV in women that had caesarean sections for breech presentation at term, and to determine the reasons why ECV was not offered or attempted for women with breech presentation, who had a caesarean section for that reason.

Breech presentation affects 3-4% of women pregnant with a single baby after 37 weeks of pregnancy. These women face two key decisions: firstly, whether or not to attempt to turn their baby by external cephalic version (ECV). Secondly, if they decide not to attempt this, or it is unsuccessful, then they need to decide how to give birth to their baby, either by planned caesarean section (CS) or vaginal breech birth (VBB). This thesis explores the process of decision making about breech presentation from both women’s and health professionals’ perspectives and documents the development of a patient decision aid (PDA), consisting of an animated film and website, for women facing these decisions in the future. In this qualitative study, data were collected using observed consultations, semi-structured interviews, with both women and professionals, and user-centred design workshops. Thirty nine women and 30 health professionals were respondents. Data were analysed using constant comparison. The results show that the diagnosis of breech presentation often comes late in pregnancy and begins with uncertainty, partly because many professionals are reluctant to provide information about options until the diagnosis is confirmed by ultrasound examination. Professionals are concerned about causing unnecessary anxiety to women who do not have a breech presentation confirmed, but such an approach fails to take account of women’s clear preference for information as soon as the possibility of breech presentation is raised. Women report researching options online and amongst their social contacts, as they strongly value experiential accounts. However they may struggle to find trustworthy information from these sources as they are frequently told horror stories. Women may also be directively counselled by professionals who have a clear preference for attempting ECV. In response to these themes, a PDA was developed which is freely available to women and includes a website summarising the evidence about the different options. In relation to decision making, women described five key values: wanting to keep their baby safe; wanting to experience a natural birth and to breastfeed; preferring to avoid surgery; needing to be able to care for other children; and wanting to have control. Postnatally, they shared vivid accounts of their experiences of ECV and birth, which were used to inform the script for the animated film that aims to provide the experiential information women wanted and also help them to explore their own values about decision making.

Background: The incidence of caesarean section for breech presentation has reached approximately 90 % in Sweden. In many of these cases, by means of specific selection criteria, it would be as safe to plan for vaginal breech delivery.   Aim: The objective of this study was to investigate differences in management and to compare maternal and fetal outcomes according to delivery mode of breech presentation; vaginal vs. caesarian section. The study included breech presentation in full term singleton pregnancies at the UppsalaUniversityHospital, Uppsala, Sweden (UAS).   Method: The study was based on medical record data with a retrospective, descriptive, comparative design with quantitative approach. The method for data collection was a manual review of patient records using a structured questionnaire.   Results: Of the women with children in breech presentation during the period studied, 11 % gave birth vaginally. Mother's wish was the most common cause of caesarean section. The group with caesarean section included more first-time mothers, longer length of stay at the hospital, increased bleeding and need for pain medication, separation from the child, later lactation and earlier introduction of formula. Vaginally delivered mothers had increased incidence of straight urine catheterization postpartum and of infants with lower Apgar scores.   Conclusion: This study does not support the suggestion that it would be safer to give birth by caesarean section for breech presentation in cases where the woman at full term meets strict selection criteria. Instead of applying medical criteria, the decision regarding mode of delivery was more often left up to the mother.

Breech presentation creates division in the consumer and healthcare communities. A number of studies report the use of scare tactics and bullying from clinicians, when women express a preference for vaginal birth after the diagnosis of a breech presenting fetus. Despite evidence showing that vaginal birth of a breech presenting fetus is safe in the presence of an appropriately skilled and experienced clinician, Caesarean Section is the primary mode of birth for breech presenting fetuses, which has resulted in a global lack of accessibility to breech birth experienced practitioners and birth mode options for women. Women planning a vaginal breech birth in a maternity care system, where the occurrence of this phenomenon is rare, face multiple challenges. Little is known of women’s breech pregnancy and birth experiences in Western Australia (WA). A mixed methods study involving semi-structured interviews, a multinational electronic Delphi (e-Delphi) study and clinical practice guideline review was designed to explore breech presentation from the perspective of women in Western Australia, and professionals with knowledge and/or experience of caring for women with a breech presenting fetus. The clinical practice guideline review provides insight into the parameters women with a breech presenting fetus planning a vaginal birth have to work within. For the clinical guideline review, clinical practice guidelines were purposively sought from leading obstetric organisations and reviewed using the International Centre for Allied Health Evidence (iCAHE) appraisal checklist. Key consistencies and inconsistencies between the guidelines were identified. Varying levels of evidence are used to support the recommendations made by professional organisations. The inconsistencies highlighted in the review have the potential to create confusion among clinicians and women and to cause issues related to valid consent, further emphasising the importance of balanced information and universal definitions for variations such as a footling presentation. The women’s aspect of this study illustrates the experiences of some women in WA. Critical theoretical concepts of knowledge and power as described by Michel Foucault, were used to describe power relations noted during clinical interactions between women and their care providers. These findings were consistent with previous reports of coercion and bullying when women’s preferences conflicted with those of their care provider. Also identified were five distinct phases women experienced throughout their breech experience – Reacting, Information, Bargaining, Decision Making and Acceptance - which showed some similarities to the Kübler-Ross model of grief. Combining the Five Stages of Breech and Foucauldian concepts of knowledge and power facilitated the identification of areas in practice which need improvement. Midwives were seen as supportive navigators of a restrictive system. The multinational e-Delphi study explored the panel’s knowledge views and recommendations of care for breech presentation. The main findings of this aspect of the study were the Breech Care Pathway provided in a midwifery-led multidisciplinary continuity of care model, a clinical skills development and maintenance framework and the proposal of a standard definition for a footling breech presentation. Providing woman-centred care in a midwifery – led multidisciplinary continuity of care model has the potential to improve the experiences and health outcomes for women and their babies. While continued improvement is needed, steps are being undertaken, particularly by midwives, to facilitate women’s autonomy and support their birth preferences. This thesis highlights current obstacles faced by women and clinicians in relation to breech presentation in contemporary maternity care. It suggests multiple ways in which this may be achieved and provides pathways and frameworks which may be used to support this process.

Thesis (MMed)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: AIM: Review outcome of pregnancies following successful external cephalic version (ECV) for breech presentation at term, particularly the caesarian section (CS) rate. ECV is a safe procedure with a minimal cost implication that can reduce non-cephalic presentation at onset of labour at term. The outcome of pregnancies following successful ECV is certainly of interest. A meta analysis of studies done between 1997 and 2004, found that pregnancies after successful ECV at term were not the same as those with spontaneous cephalic presentations and was associated with a CS rate twice that in pregnancies with spontaneous cephalic presentations. The conclusion was that pregnancies after successful ECV should not be considered the same as normal pregnancies. In a matched retrospective analysis of CS risk after successful ECV, done in the USA, it was concluded that CS delivery and operative vaginal delivery rates following successful ECV, were not increased. To date there are no such studies in South Africa. METHODOLGY: A retrospective descriptive study was done to audit all successful ECV’s done at the Fetal Evaluation Clinic (FEC) of Tygerberg Academic Hospital. The electronic data from the FEC was searched for successful ECV patients. The facilities where these patients delivered were identified. The outcome of the pregnancies was determined from patient files and/or the labor registers. The relevant information of each patient was captured. All file reviews and data capturing was done by the principal investigator. RESULTS: A total of 78 patients were included in the study. The median age was 28.7 years with a range from 17 to 40 years, the median parity 1 and the range 0 to 6 and the median body mass index 27.2 and the range 18.2 to 45.0. The method of determining gestational age is known in 71 (91%) patients of whom 37 (52%) had an early ultrasound examination. The median gestational age at ECV was 37 weeks with the inter quartile range 36 to 38 weeks. The median ECV to delivery time was 2 weeks with the inter quartile range 1 to 4 weeks. Higher levels of care were required at time of delivery by 47 (60.3%) patients. Vaginal deliveries occurred in 49 patients and 29 (37.2%) had CS. The most common indications for CS were cephalo pelvic disproportion 8, fetal distress 6, reversion back to breech presentations 4 and other abnormal presentations 4 (2 face presentations and 2 transverse lies). The mean birth weight of the babies was 3360g and the range 2100 to 4655g. On comparing the groups that had vaginal deliveries and CS, only nulliparous patients had a significantly (p=0.02) higher risk for CS. CONCLUSIONS: Following successful ECV all patients need to be carefully followed up for possible reversion to breech presentation or transverse lie. Nulliparous and gravid 2 para 1 patients with a previous CS need to be delivered in hospitals with CS facilities. Further studies are required to assess whether successful ECV results in more face presentations.
AFRIKAANSE OPSOMMING: DOELWIT: Om die uitkoms van swangerskappe na suksesvolle eksterne kefaliese kerings (EKK) vir stuit presentasies op voltyd, spesifiek die keisersnit (KS) insidensie te bepaal. EKK is ‘n veilige prosedure wat teen minimale koste die nie-kefaliese presentasies op voltyd kan verminder. Die uitkoms van swangerskappe na suksesvolle EKK is van belang. ‘n Meta-analise van studies gedoen tussen 1997 en 2004 vind dat swangerskappe na suksesvolle EKK op voltyd nie dieselfde is vergeleke met spontane kefaliese presentasies nie en gepaard gaan met ‘n KS koers tweekeer hoër as dié met spontane kefaliese presentasies op voltyd. Die gevolgtrekking was dat swangerskappe na suksesvolle EKK nie as normale swangerskappe beskou moet word nie. In ‘n gepaarde retrospektiewe ontleding van die KS risiko wat in die VSA gedoen is, word gevind dat die KS en operatiewe vaginale verlossing koerse na suksesvolle EKK, nie verhoog is nie. Tot op hede is daar geen studies hieroor in Suid-Afrika gedoen nie. METODE: ’n Retrospektiewe beskrywende studie is gedoen om all suksesvolle EKK wat by die Fetale Evaluasie Kliniek (FEK) gedoen is te oudit. ‘n Elektroniese data soektog van suksesvolle EKK by die FEK is gedoen. Die instellings waar die pasiënte verlos is, is vasgestel. Die uitkoms van die swangerskappe is bepaal deur pasiënt lêers en/of die kraamregisters na te gaan. Die relevant inligting oor elke pasiënt is versamel. RESULTATE: ‘n Totaal van 78 pasiënte is by die studie ingesluit. Die mediane ouderdom was 28.7 jaar met ‘n reikwydte van 17 tot 40 jaar, die mediane pariteit was 1 met ‘n reikwydte van 0 tot 6 en die mediane liggaamsmassa indeks 27.2 met ‘n reikwydte van 18.2 tot 45.0. Die metode waavolgens swangerskapsduurte bepaal is, was bekend in 71 (91%) van pasiënte, waarvan 37 (52%) vroeë ultraklank ondersoeke gehad het. Die mediane swangerskapsduurte tydens die EKK was 37 weke met die interkwartiele interval 36 tot 38 weke. Die mediane EKK tot verlossing tydsverloop was 2 weke met die interkwartiele interval 1 tot 4 weke. Hoër vlakke van sorg was nodig ten tye van die verlossing by 47 (60.3%) van pasiënte. Van die pasiënte het 49 vaginale verlossings en 29 (37.2%) KS gehad. Die mees algemene indikasies vir KS was skedel-bekken disproporsie 8, fetale nood 6, terugkeer na stuitpresentasie 4 en abnormale presentasies 4 (2 aangesigsliggings en 2 transversliggings). Die gemiddelde geboorte gewig van die babas was 3360g en die reikwydte 2100 tot 4655g. Wanneer die groep wat vaginale verlossing en KS gehad het vergelyk word, het slegs nullipareuse pasiënte ‘n betekenisvolle (p=0.02) hoër risiko vir KS gehad. GEVOLTREKKING: Na suksesvolle EKK moet alle pasiënte noukeurig opgevolg word vir terugkeer na ‘n stuit presentasie of transversligging. Nullipareuse en gravida 2 para 1 pasiënte met ‘n vorige KS moet in hospitale met KS fasiliteite verlos word. Verdere studies is nodig om te bepaal of suksesvolle EKK meer aangesig presentasies tot gevolg het.

Thesis (MMed)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: The Objective: To review the difference in short term neonatal and maternal outcomes among singleton infants with breech presentation delivered by vaginal or elective caesarean section route at term, at Tygerberg Academic Hospital (TBH) in Cape Town. The study design was a retrospective case control study. Method: Part I A total of 120 patients were selected. 60 vaginal breech deliveries and 60 elective caesarean sections for breech presentation (comprising the control group). 60 cases of vaginal deliveries were collected and 60 control cases of planned elective caesarean sections, where the indication for CS was breech presentation, were collected in the same manner. Part II Nineteen registrars completed a questionnaire regarding their subjective experiences of vaginal breech deliveries at Tygerberg Academic Hospital. Results: Part I An analysis of the results found statistically significant differences in maternal ages between the two groups, with younger women delivering by CS; gravidity and parity was lower in the CS group; blood loss was observed to be higher in the CS group with more women requiring a blood transfusion when compared to vaginal delivery; there were more neonatal admissions in the vaginal delivery group as well as more birth trauma, neonatal seizures and death in this group; Apgar scores were higher in the CS group and finally, neonates born by CS were more commonly discharged at the same time as their mothers in the CS group. Part II When analyzing the registrar questionnaire it can be noted that although clinicians are performing an adequate number of breech vaginal deliveries, with an average of 10 deliveries per year, the skills training for clinicians is invaluable. Not all registrars learned skills from a senior clinician and skills training in skills labs are essential for initial and even continual training of these clinicians. It is suggested that these skills training programs be made compulsory for all registrars and that a biyearly attendance and completing of such a course be mandatory for those wishing to work in the labour ward. Conclusions: Although not statistically significant, there was more morbidity and mortality associated with vaginal breech delivery.
AFRIKAANSE OPSOMMING: Doel: Om die korttermyn neonatale en moederlike uitkomste van enkeling swangerskappe met stuitligging wat vaginaal of met elektiewe keisersnee verlos is by die Tygerberg Akademiese Hospitaal in Kaapstad, te bepaal. Die werkstuk is ‘n retrospektiewe gekontroleerde-gevallestudie. Metode: Deel 1 ‘n Totaal van 120 pasiënte is gekies. 60 gevalle van vaginale stuitverlossings en 60 kontrolegevalle van beplande elektiewe keisersnitte waar die indikasie stuitligging was. Deel 2 Negentien kliniese assistente het die vraelys oor hul persoonlike ervaring van vaginale stuitverlossing by die Tygerberg Akademiese Hospitaal ingevul. Resultate: Deel 1 ‘n Ontleding van die resultate wys statisties betekenisvolle verskille in die moederouderdom van die twee groepe, met meer jong vroue wat met keisernit geboorte gee. Graviditiet en pariteit was laer in die keisersnit-groep. Bloedverlies was hoër in die keisersnit-groep en in vergelyking met die vaginale verlossings met meer vroue wat bloedoortapping benodig. In die vaginale verlossingsgroep was meer neonatale toelatings nodig asook meer geboortetrauma, neonatale konvulsies en sterftes. Apgar-tellings was hoër in die keisersnitgroep en neonate wat met ‘n keisersnitte gebore is, is meer dikwels saam met hul moeders ontslaan. Deel II Ontleding van die vraelys vir kliniese assistente wys dat hoewel klinici ‘n genoegsame getal van gemiddeld 10 vaginale stuitverlossings per jaar uitvoer, vaardigheidsopleiding vir klinici van onskatbare waarde sal wees. Nie alle kliniese assistente leer vaardighede by senior klinici nie en opleiding in ‘n vaardigheidslaboratorium is noodsaaklik vir die aanvanklike en selfs voortdurende opleiding van dié kliniese assistente. Dit word voorgestel dat hierdie vaardigheidkursusse verpligtend gemaak word vir alle kliniese asssistente en bywoning en voltooiing van die kursus twee maal per jaar verpligtend moet wees vir diegene wat in ‘n kraamsaal wil werk. Gevolgtrekking: Vaginale stuitverlossings, hoewel nie stastisties betekenisvol nie, het met meer morbiditeit en sterftes gepaardgegaan.

Contexte : Le management de la présentation foetale en siège est complexe car la littérature scientifique est contrastée. Objectif : Mettre en évidence les effets des attitudes et des interventions professionnelles sur le vécu des femmes. Méthodes : Cinq recherches quantitatives et qualitatives, incluant 311 participantes, ont été menées à la maternité des Hôpitaux Universitaires de Genève. Résultats : Les femmes doivent souvent faire un deuil par anticipation de l'accouchement idéalisé. Elles sont très motivées à tenter de corriger la malposition foetale. 69% des participantes ont recours aux médecines alternatives et complémentaires pour se soigner. 68% des participantes ont qualifié la tentative de version céphalique externe (VCE) de « forte à insupportable. Un accompagnement par hypnose ne réduit pas l'intensité de la douleur, comparé à un accompagnement par une sage-femme (échelle visuelle analogique : 6,0 vs 6,3 /10 respectivement, p=0.25). Pour le choix du mode d'accouchement les femmes ont rapporté des conflits décisionnels majeurs. L'information médicale est souvent perçue en faveur de la césarienne élective. Le sentiment de contrôle, les émotions et les premiers instants avec le nouveau-né sont perçus différemment selon le mode d'accouchement, en défaveur de la césarienne en urgence. Conclusion : Un processus émotionnel et décisionnel inattendu et souvent difficile est associé au diagnostic de siège. Développer des outils d'aide à la décision pour la femme, et des techniques de relation d'aide pour les professionnels faciliteraient ces processus. La prise en charge de la douleur durant la tentative de VCE est indispensable
Context: Management of breech remains complex due to divergence of practices and recommendations reported in the literature. Objective: To highlight the effects of health professionals' interventions on women's experiences. Methods: Five research studies qualitative were conducted at the University Hospitals of Geneva, including a total of 311 participants. Two studies used a method with interviews and thematic analysis, two used a quantitative method with a statistical analysis, and one used a mixed methods' design. Results: Breech diagnosis often requires anticipating a disappointment of an idealized childbirth. Women demonstrate a strong motivation to try to turn their fetus. 69% of women use complementary and alternative medicine (CAM) for their treatment. 68% of participants qualified external cephalic version (ECV) as "strong to unbearable". An accompaniment by a hypnotist compared to a midwife did not decrease pain intensity (visual analogic scale: 6.0 vs 6.3/10, respectively; p=.25). For the choice of breech delivery mode, women reported strong decisional conflicts. Medical information is often perceived in favour of a planned caesarean. Feelings of control, emotions and the first moments with the newborn are perceived differently and, notably, negatively in the case of emergency ceasarean section. Conclusion: A difficult emotional and decision-making process is associated with term breech. Use of CAM should be considered by professionals. Developing tools to assist women, and relationship techniques for professionals could facilitate these processes. Reduction of pain during ECV is necessary

Lau, Tze Kin.
"May 1998."
Thesis (M.D.)--Chinese University of Hong Kong, 1998.
Includes bibliographical references (p. 165-178).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.

Breech malpresentation is associated with maternal-infant morbidity and mortality. Maternal knee-chest posture is a clinical practice intended to reduce the incidence of breech presentation and its concomitant risks in pregnancy. However, research on postural management has been inconclusive. This randomized clinical trial investigated whether knee-chest posture is associated with a higher proportion of breech infants converting to cephalic presentation during pregnancy. The study was conducted with 25 pregnant women whose infants were in breech presentation at 34–38 weeks gestation. Gestational age, parity, race, and treatment were evaluated for effect on version using Fisher exact tests. Gestational age, parity and treatment met screening criteria (p ≤ .25) for significance in the univariate analyses. Logistic regression was not employed due to zero cells in some of the univariate contingency tables. Effects of the intervention on infant presentation in labor, mode of delivery, birthweight, and 5-minute Apgar were examined by Fisher exact tests. There was no significant effect of intervention on birth outcomes at the p ≤ .05 level. Data from this study of 25 women were combined with data from two previous randomized trials for the same intervention. There was no effect of knee-chest posture on breech presentation in pregnancies over 36 weeks gestation. Implications for nurses and obstetric care providers include knowing that postural management of breech pregnancy is not yet adequately tested, advising clients accordingly and participating in the research to establish whether knee-chest posture promotes cephalic version of breech presentation.

Background Vaginal breech delivery can be a difficult obstetric procedure. The well-known Term Breech Trial concluded that planned elective caesarean section at term was safer for the babies than planned vaginal birth. This resulted in widespread adoption of protocols favouring planned caesarean section for breech presentation. However, daily experience shows that vaginal breech deliveries are still conducted in our hospitals. Objectives and methods This study was done to: 1) determine the reasons why vaginal breech deliveries still occur with live babies at Chris Hani Baragwanath hospital, despite the adoption of a protocol for elective caesarean section for breech presentation at term; 2) to audit the quality of clinical notes given the potential medicolegal hazards associated with breech delivery; and 3) to describe neonatal morbidity and mortality associated with vaginal breech delivery. This was a retrospective descriptive study and audit of vaginal breech deliveries, using a period sample of vaginal breech births of babies alive at the onset of the second stage of labour, and weighing 800 g or more at birth. Data collection was by review of maternal and neonatal case notes. Results Results There were 90 women with eligible vaginal breech deliveries. Four (4%) were referred from midwife-run antenatal clinics for breech presentation. External cephalic version was not attempted on any of these women. Five (6%) had been booked for elective caesarean section. On admission in labour, 26 (29%) of these breech presentations were missed, and 23 (26%) had emergency caesarean sections booked. The vaginal deliveries were conducted by registrars in 55 cases (61%) and by midwives in 22 (24%). At delivery, the fetal heart was noted to be present in 28 cases (31%). The method of delivery of the head was stated in 23 deliveries (26%). The median birthweight was 2370 g (interquartile range 1730-3000 g). There were eight babies weighing less than 1000 g (9%). There were eight perinatal deaths (9%), of whom four weighed more than 2500 g. There was one where the aftercoming head could not be delivered with the baby eventually born as a fresh stillbirth. Conclusion There may be a problem with clinical skill in detecting breech presentation, and with supervision of vaginal breech deliveries by senior obstetric staff. Note-keeping, with a view to preventing medicolegal risks, was generally poor. However, the majority of vaginal breech deliveries occurred without warning even in the presence of standard antenatal and intrapartum care. This means that vaginal breech deliveries will continue to occur in this institution. Clinicians must remain skilled in vaginal breech delivery and understand the importance of following standard protocols and operating procedures, especially in note-keeping, to prevent poor clinical outcomes and associated medico-legal hazards.

External cephalic version (ECV) involves turning a fetus in utero by manipulation through the maternal abdomen and the uterine wall.
Many clinicians and patients, however, still decline ECV in favour of Caesarean section. This could be due to the lack of experience of ECV, and fear of complications or pain during the version.
Summary. The force applied during ECV can be measured and analysed using a customized pair of gloves incorporating piezo-resistive pressure sensors and suitable analytical software. The degree of force required for a successful version is highly variable. Failure of version is not usually due to insufficient force. Uterine tone is the most important factor affecting the degree of force applied during a version attempt. The degree of force applied is associated with the changes in fetal cerebral blood flow after ECV, and the amount of pain perceived by the patients. (Abstract shortened by UMI.)
The lack of information in this area is primarily due to the lack of a suitable device that would allow measurements of the force applied without interfering with the ECV. A suitable device would therefore have to be sufficiently robust so that it could be worn on the hands, durable so that it could be used repeatedly, incorporate multiple individual sensors, each of which is capable of making dynamic and mutually independent measurements during the version procedure.
There is no report in the literature on quantification of the force applied during ECV. It is also unknown whether the degree of force applied is related to the version outcome. In particular, it is unclear whether a failed attempt is related to insufficient force, or whether an increase in force may help to achieve version after a failure. Furthermore, it is also not known if any patients' factors may influence how much force is applied through the operator's hands. Although the chance of successful version could be predicted by some clinical factors, whether these factors may also affect the degree of applied force is not known.
This thesis reports on the design and development of a suitable measuring device fulfilling the requirements described above. In addition, it will test a number of hypotheses relating to the degree of force applied during ECV and clinical feto-maternal parameters and outcomes, in a study cohort of 92 patients.
Leung Tak Yeung.
"April 2005."
Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717.
Thesis (M.D.)--Chinese University of Hong Kong, 2005.
Includes bibliographical references (p. 155-174).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
School code: 1307.

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This paper focuses on vaginal breech birth of singleton babies in New Zealand using a review of international literature to inform discussion on the care of women presenting at term with an uncomplicated breech presentation.