Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
J Matern Fetal Neonatal Med. 2022 May;35(9):1712-1718. doi: 10.1080/14767058.2020.1768237. Epub 2020 May 20.
Decreasing the primary cesarean delivery rate and associated maternal and fetal complications is a priority for obstetric care providers. External cephalic version (ECV) is a procedure recommended for women with singleton pregnancies where the fetus is malpresenting to avoid vaginal breech delivery, which is inherently riskier than cesarean delivery. However, little is known about this procedure in the context of twin gestations. Scheduled cesarean delivery is instead recommended for women with twin gestations where the presenting twin is not cephalic. Our aim is to evaluate the safety and efficacy of ECV in the setting of twin pregnancy where the presenting twin is not cephalic. We also present two patients with twin pregnancy at our institution that attempted ECV.
A systematic review of the following electronic databases was performed, searching from their inception until September 2019: Pubmed, Ovid, Scopus, and clinicaltrials.gov.
All reported cases of ECV for a non-cephalic presenting twin were included. Studies were excluded if patients had contraindications to vaginal delivery and if they described ECV of the second twin only. Maternal demographics, procedure details, and outcomes data were collected.
The primary outcome was a successful version of the presenting twin to the cephalic presentation following ECV. Statistical analysis involved calculating means, standard deviations, frequencies and percentages as appropriate.
Two case reports and one case series, totaling 22 patients, met inclusion criteria. Two additional patients attempted ECV at our institution. One completed ECV (for a total of 23 patients) while the other did not. This patient consented for ECV as Twin A was noted to be breeched upon presentation to labor and delivery but after receiving regional anesthesia, twin A was cephalic. No randomized controlled trials were identified. All were dichorionic pregnancies. Successful ECV of twin A occurred in 57% (13/23) of women and 48% (11/23) had a successful vaginal delivery. The majority were performed using regional anesthesia and a uterine relaxant (20/23). No serious adverse events occurred in any of the reports.
ECV is insufficiently studied in twin pregnancy. Based on very limited data, it appears feasible to turn the non-cephalic presenting twin. Additional randomized controlled trials are needed to further evaluate the safety and efficacy of this procedure for a non-cephalic presenting twin.
降低初次剖宫产率和相关母婴并发症是产科护理提供者的首要任务。经阴道外倒转术（ECV）是一种推荐用于单胎妊娠中胎儿胎位不正的方法，可避免阴道臀位分娩，后者的风险明显高于剖宫产。然而，对于双胎妊娠，人们对这一程序知之甚少。对于双胎妊娠中头位先露的产妇，建议行计划性剖宫产。我们的目的是评估 ECV 在头位先露的双胎妊娠中的安全性和有效性。我们还介绍了在我们机构进行 ECV 的两例双胎妊娠患者。
对以下电子数据库进行了系统回顾，从其成立到 2019 年 9 月进行了检索：Pubmed、Ovid、Scopus 和 clinicaltrials.gov。
所有非头位先露的 ECV 报告病例均被纳入。如果患者有阴道分娩禁忌证，或仅描述第二胎 ECV，则排除这些研究。收集了产妇人口统计学、程序细节和结局数据。
主要结局是 ECV 后头位先露的胎儿转为头位。统计分析包括计算均值、标准差、频率和百分比。
有两例病例报告和一篇病例系列报告，共 22 例患者符合纳入标准。另外 2 例患者在我们机构尝试 ECV。1 例成功（共 23 例），另 1 例未成功。该患者同意行 ECV，因为在出现至产房时发现 Twin A 臀位，但在接受区域麻醉后，Twin A 转为头位。没有发现随机对照试验。所有病例均为双绒毛膜妊娠。57%（13/23）的妇女 ECV 成功，48%（11/23）阴道分娩成功。大多数采用区域麻醉和子宫松弛剂（20/23）。所有报告均未发生严重不良事件。
ECV 在双胎妊娠中的研究不足。根据非常有限的数据，似乎可以将非头位先露的胎儿转成头位。需要更多的随机对照试验来进一步评估该程序对非头位先露胎儿的安全性和有效性。
