Thesis (Ph.d.)--University of Alberta, 1997. / Submitted to the Faculty of Graduate Studies and Research in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Faculty of Rehabilitation Medicine. Also available online.

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.

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.

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.