Türkiyede Tek Merkezde Eksternal Sefalik Versiyon Çalışması

Abstract

Giriş ve Amaç: Güvenli ve etkili olduğu ispatlanmış olan eksternal sefalik versiyon (ECV) makat prezentasyon ve sezaryen oranını azaltarak maternal ve neonatal sonuçları iyileştirir. Çalışmamızda Türkiye’deki makat prezentasyonlu term gebelerde eksternal sefalik versiyon uygulamasının etkinliğini ve uygulanabilirliğini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Tek bir merkezde yürütülen bu prospektif gözlemsel çalışmaya 36. gebelik haftasında veya sonrasında makat prezentasyonunda fetüs bulunan 153 gebe kadın dahil edildi. 130 hasta ECV'yi kabul etmedi ve bu hastalar kontrol grubu olarak takip edildi. ECV 23 hasta tarafından kabul edildi ancak fetüslerden birinin işlemden önce kendiliğinden verteks prezentasyonuna döndüğü gözlendi ve bir hasta başarılı bir ECV'den sonra takip edilmedi. Sonuç olarak çalışma grubu 21 hasta olarak belirlendi. Bulgular: İki grup arasında karakteristik özellikler açısından istatistiksel olarak anlamlı fark yoktu. ECV grubunda doğumda verteks prezentasyon oranı %71,4 iken ECV uygulanmayan grupta %12.5 idi (p<0.001). ECV uygulanan ve uygulanmayan gruplarda sezaryen oranı sırasıyla %57,2 ve %92.3 idi (p< 0.05). Verteks prezentasyonlu fetüslerin vajinal doğum oranı ise iki grup arasında benzerdi ( %60'a karşı 62,5, p=0,589). Sonuç: Ülkemizde rutin olarak uygulanmasa ve kadın doğum hekimleri ve hastalar tarafından çok iyi bilinmese de, ECV'nin makat gelişi ve zamanında sezaryen oranlarını azaltmada istatistiksel olarak etkili olduğu görülmüştür.

Keywords

• Makat prezentasyon
• Sezaryen
• External sefalik versiyon

External Cephalic Version Study in a Single Center in Turkey

Abstract

Aim: External cephalic version (ECV) has been proven to be safe and effective, and improves maternal and neonatal outcomes by reducing the rate of breech presentation and cesarean section. In our study, we aimed to evaluate the effectiveness and feasibility of external cephalic version in term pregnancies with breech presentation in Turkey. Method: This prospective observational study conducted in a single center included 153 pregnant women with a fetus in breech presentation at or after 36 weeks of gestation. 130 patients did not accept ECV and these patients were followed up as the control group. ECV was accepted by 23 patients however, one of the fetuses was observed to return to vertex presentation before the procedure spontaneously and one patient did not continue follow-up after a successful ECV. Consequently, the study group was determined as 21 patients. Results: There was no statistically significant difference in characteristic features between the two groups. The rate of vertex presentation at birth was 71.4% in the ECV group and 12.5% in the non-ECV group (p<0.001). The cesarean section rate was 57.2% and 92.3% in the ECV and non-ECV groups, respectively (p<0.05). The rate of vaginal delivery of vertex-presenting fetuses was similar between the two groups (60% vs. 62.5%, p=0.589). Conclusion: Although it is not a routine practice in our country and is not well known by obstetricians and patients, ECV is statistically effective in reducing breech presentation and term cesarean section rates.

Keywords

• Breech presentation
• Cesarean section
• External cephalic version

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