To evaluate pronostic factors of the external cephalic version.Material and methodsA retrospective study of 439 external versions between January 1, 1996 and June 30, 2007 in a level III maternity in Brussels.ResultsThe success rate of external cephalic version in this series was 37.6%. No major fetal complication was observed. Multiparity, newborn weight over 3000 g, fetal position with the back on the right, medical expertise and maternal weight gain during pregnancy less or equal to 9 kg are good pronostic factors. According to this success rate and the caesarean section rate for breech presentation during this period, we can estimate that one caesarean would be avoided for every five to six attempts of versions.ConclusionExternal version in case of breech presentation at term deserves to be tempted. This technique appears to be well-tolerated by fetuses and reduces the number of caesarean sections. Success rate will be higher when the patient presents one or more good pronostic factors described above. Purchase PDF (279 K)Version par manoeuvre externe: Experience a la maternit...Journal de Gynecologie Obstetrique et Biologie de la Re... Version par manœuvre externe: Expérience à la maternité Port-Royal à partir de 237 versionsJournal de Gynecologie Obstetrique et Biologie de la Reproduction, Volume 33, Issue 4, June 2004, Pages 297-303T. Le Bret, G. Grangé, F. Goffinet, D. CabrolAbstractRésuméButMontrer que la version par manœuvre externe (VME) des présentations du siège à terme permet de réduire le taux de césariennes de ces présentations, tout en s’assurant de la bonne tolérance fœtale de cette pratique.Matériels et methodsÉtude rétrospective portant sur 237 VME entre le 1er janvier 1998 et le 31 décembre 2000 à la maternité Port-Royal.RésultatsLe taux de succès de la VME est de 50,6%. La voie basse est accordée selon des critères stricts en cas d’échec. Le taux de césariennes est de 12,5%en cas de succès, et de 53%en cas d’échec, les deux tiers étant programmés avant travail. Au final, 67%des sièges ont accouché par les voies naturelles. On retrouve 3,4%d’anomalies du RCF et 2,9%de test de Kleihauer positifs au décours de la VME, sans aucun accident grave rapporté. La réussite de la version est liée de façon significative à la multiparité, à un siège haut et complet et à une quantité de liquide normale.ConclusionLa pratique régulière de la VME permet de diminuer le taux de césariennes des présentations du siège de 20,5%et donc de diminuer la morbidité maternelle. Elle peut être proposée après information aux patientes, si l’on respecte les contre-indications et une surveillance fœtale.SummaryObjectivesTo evaluate the effectiveness of external cephalic version for reducing the rate of cesarean section by preserving fetal safety.Materials and methodsA retrospective review of 237 external cephalic versions between January 1, 1998 and Decembre 31, 2000 was conducted at Port Royal maternity.ResultsThe success rate of external cephalic version was 50.6%. When version failed vaginal birth could be allowed after strict evaluation. The rate of cesarean section was 12.5%in the success group and 53%in the unsuccessful group, two thirds were planned. The overall rate of vaginal birth among breech presentations was 67%. After version there were 3.4%abnormal fetal heart rate tracings and 2.9%positive Kleihauer tests. No major complications occurred. Successful external cephalic version was associated with statistically significant higher multiparity, complete breech out of the pelvis and normal amniotic fluid volume.ConclusionExternal cephalic version reduces the cesarean section rate by about 20.5%among breech presentations and so, lowers maternal morbidity. External cephalic version could be proposed to the patients when safety criteria are respected and close fetal monitoring is maintained. Purchase PDF (62 K)View More Related Articles doi:10.1016/j.gyobfe.2008.02.001 Copyright © 2008 Published by Elsevier Masson SAS Débat Faut-il faire ou non des versions par manœuvres externes (VME) ?

Although prenatal sonography remains the primary imaging method for screening fetal anomalies, fetal MRI with ultrafast imaging technique is a complementary imaging method as soon as the second trimester. It allows better tissue contrast images than does US, a large field of view of the foetus and is not limited by large maternal body habitus and oligohydramnios, without any risk for the foetus. In the future, the development of new techniques (diffusion-weighted imaging, proton MR spectroscopy) and faster sequences will make it possible to widen the indications i.e. cardiac, functional renal and cerebral imaging.