Which factors play a role in clinical decision-making in external cephalic version?

Abstract

Objective. To assess the clinical factors that influence the estimates of clinicians of the success of an external cephalic version (ECV), and the subsequent management decisions made by clinicians. Design. We constructed 16 fictional vignettes of women with a term fetus in breech position eligible for ECV. Setting. Secondary and tertiary clinics in The Netherlands. Population. Thirty-seven gynaecologists, residents and midwifes. Methods. Sixteen case summaries concerning a hypothetical patient eligible for ECV. Potential prognostic factors that varied between the cases were parity, maternal body mass index, engagement of the fetus, amniotic fluid, fetal growth, fetal presentation and placental localisation. For each case presentation, the clinicians were asked for their inclination to perform an ECV, and whether or not they would use tocolysis. Results. The estimated probabilities of success varied between 20 and 60%. The number of clinicians that would attempt an ECV varied per case between 32 and 97%. Amniotic fluid and engagement contributed 80% of the variation in the decision to perform ECV. In the case of oligohydramnios or an engaged breech, the clinicians tended not to perform an ECV. Conclusion. Amniotic fluid and engagement seem to be the main factors in the clinical decision-making of clinicians in ECV. This decision-making is probably experience based. Systematic knowledge of clinical prognosticators and subsequent assessment of their prognostic capacity is needed.