Regional Differences in External Cephalic Version and Management of Vaginal Breech Delivery: A Survey in the Netherlands

Abstract

Background: This study aims to gain insight into external cephalic version (ECV) and regional differences in management of vaginal breech delivery in the Netherlands.

Methods: A nationwide online survey was sent to the obstetric department of each hospital (n = 80).

Results: The response rate was 81% (65 of 80 hospitals). All centers performed ECV and 98% offered ECV to more than 90% of the eligible women. ECV was mostly performed by gynecologists (89%). A special ECV outpatient clinic existed in 35% of the centers, ECV was conducted at the regular outpatient clinic in 15% and in 44% ECV was conducted in the clinic. For uterine relaxation atosiban (46%) was the most given, followed by ritodrine (32%), fenoterol (18%) and nifedipine (4%). All centers are experienced in vaginal breech delivery. Induction for obstetrical reasons was allowed in 72% and labor augmentation, if needed, was administered in 83% of the responders. Pain relief for vaginal breech delivery was offered in all centers when requested. A selected team of gynecologists assisting vaginal breech delivery existed in 28% of the centers. Preterm vaginal breech delivery was possible in 92% of the centers.

Conclusions: In the Netherlands, ECV is well implemented, and large variations in practice concerning ECV and the use of several tocolytic agents for ECV exist. Vaginal breech delivery at term is possible in all centers; however, intrapartum management of vaginal breech delivery differs among centers.

J Clin Gynecol Obstet. 2020;9(1-2):3-11
doi: https://doi.org/10.14740/jcgo624