Comparison of Materials used in Facilitating External Cephalic Version

Abstract

Background

External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce number of assisted breech deliveries and caesarean sections for breech presentation . Talcum powder or aqueous gel is frequently used to facilitate ECV. We  compared powder with gel in attaining successful version and  level of practitioner satisfaction with powder versus gel use.

Methodology

This retrospective descriptive study was conducted by –removed for blind review---10^th Oct 2015- 10^th Oct 2019 . Total of 56  low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using  convenient consecutive sampling, powder or gel during ECV was allocated accordingly . ECV was performed by the  single experienced practitioner in labour room with  cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining successful version . ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECV’s were reattempted with crossover use to the other aid. Practitioner satisfaction  was defined  as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while  using powder or gel during ECV. The data was recorded  & analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version & practitioner satisfaction level with powder versus gel use.

 Results

In powder use group , 9  ECV’s were successful and 19 ECV’s  were unsuccessful. In gel use group , 12  ECV’s were successful and 16 were unsuccessful .There were more successful ECV’s in gel group but the association was not significant (P value .408). Practitioner satisfaction was  significantly high with gel than  the powder use(Pvalue .<.001).

Conclusion

Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than the powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice.