External Cephalic Version in Twin Pregnancy [13N]. (May 2020)

• Record Type: Journal Article
• Authors: Felder, Laura; McCurdy, Rebekah; Berghella, Vincenzo
• Is Part Of: Obstetrics and gynecology. Volume 135(2020)Supplement 1
• Publication Date: 2020-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000663708.76802.e2
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Decreasing the primary cesarean delivery rate and associated maternal and fetal complications is a priority for many obstetric providers. External cephalic version is a procedure recommended for women with singleton pregnancies where the fetus is malpresenting as vaginal breech delivery is inherently riskier than either vaginal or cesarean delivery. However, little is known about this procedure in the context of twin gestations. Women with twin gestations where the presenting fetus is not cephalic are instead recommended to undergo scheduled cesarean delivery. METHODS: A systematic review of the following electronic databases was performed, searching from their inception until September, 2019: MEDLINE, Ovid, Scopus, and clinicaltrials.gov . All reported cases of external cephalic version in twin pregnancy were included. Maternal demographics, procedure details, and outcomes data were collected. The primary outcome was successful version of the presenting twin to the cephalic presentation. Statistical analysis involved calculating means, standard deviations, frequencies and percentages as appropriate. RESULTS: Two case reports and one case series, totaling 22 patients, met inclusion criteria. No randomized controlled trials were identified. All were dichorionic pregnancies. Successful external cephalic version of twin A occurred in 60% (13/22) of women and 50% (11/22) had a successful vaginal delivery. The majority were performed using regional anesthesia and a uterine relaxant (19/22). No serious adverse events occurred in any of the reports. CONCLUSION: External cephalic version appears to be safe and effective for dichorionic twins where the presenting twin is malpresenting. Additional randomized controlled trials are needed to further evaluate this intervention for this patient population.