Rebozo and External Cephalic Version in Breech Presentation.

Study Overview
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Brief Summary
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Breech presentation occurs in approximately 3-5% of all pregnancies, and breech birth is more complicated and risky for the fetus than births of fetuses in the cephalic position. Therefore, it is desirable to turn the fetus from breech presentation to cephalic position before labour. This is traditionally done by external cephalic version, where the doctor manually tries to turn the fetus; the success rate of this is approximately 50%, and complications occur in about 0.5%. In addition there is discomfort and pain to the pregnant woman. The investigators will assess the effect of using the rebozo prior to the external version. Use of rebozo is a recognized technique from Mexico, where the midwife with a scarf 'shake' the pregnant woman's pelvis over several sessions, so the fetus spontaneously turns to cephalic presentation or the external version is facilitated. There are no known complications associated with the rebozo method. Use of rebozo in breech presentation has never before been studied scientifically, but is used in many places in the world. The investigators are planning an open-labeled randomized controlled study in pregnancies with verified breech or transverse presentation: by lot either standard external cephalic version or preceding rebozo-treatment with subsequent external cephalic version. The investigators want to assess whether the use of rebozo - either as pre-treatment for external cephalic version or as a catalyst of spontaneous version - will increase the incidence of the cephalic presentations at labour and thus reduce the number of planned caesarean section. The population will be pregnant women with ultrasound verified breech or transverse presentation;all women who fulfill the local guideline criteria for external cephalic version, can be included. Exclusion criteria are non-Danish speaking or reading. The recruitment will be conducted by midwife at week 35 in the antenatal care. The study design will be open-labeled randomized controlled. Randomisation is done by closed envelope method and stratified by parity. Intervention is rebozo exercises performed over 3-5 days from randomization. In case of persistent breech presentation, the woman is offered standard external cephalic version. The control group will also be offered external cephalic version after 3-5 days from randomization. The investigators will use source data from existing local databases, Obstetrics Database and version Database, for collecting birth outcome. In all stages of intervention documented electronically by project midwives. The primary objective is the number of successful versions in total, i.e., after intervention and external cephalic version. We expect to increase the success rate from 50% to 65%, thus requiring 378 women in the study. Secondary objectives are the number of successful vaginal births with birth in head position and total number of caesarean.

Official Title
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Rebozo Som Vendingsmetode Ved sædepræsentation (in Danish)

Conditions
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Breech Presentation

Intervention / Treatment
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* Behavioral: Rebozo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Understands Danish in writing. Intention of accepting vaginal delivery if cephalic presentation. Can be offered standard treatment of external cephalic version according to local guidelines, e.g.: Singleton pregnancy Fetus in breech or transverse position The gestational age at randomization must be between 35w+0/7d and 37w+4/7d so that the ECV is no later than 38w+0/7d for parous and 37w + 0/7d for nulliparous women. Exclusion Criteria: Women that cannot be offered external cephalic version according local guideline, e.g.: placenta praevia and vasa praevia. Suspicion of severe fetal growth restriction. Severe preeclampsia. Uterus anomalies.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rebozo<br>Intervention by Rebozo | Behavioral: Rebozo<br>* Shaking of the maternal pelvis by the midwife to increase the spontaneous cephalic version rate in breech presentation.<br>|
| No Intervention: Control<br>Standard | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cephalic presentation |  | After external cephalic version | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Version rate by the intervention only |  | Before external cephalic version | 
| Version rate by the standard external cephalic version |  | At the external cephalic version | 
| Rate of cesarean section by intervention and presentation. |  | In labour | 
| Dystocia in labor in cephalic presentation after version | Use of Pitocin, vacuum extraction and time frame. | In labour | 
| Inducement of labour |  | Before labour | 
| Time frames for rupture of membranes, labour, first and second stage labour |  | In Labour | 
| Number of women having epidural |  | In labour | 
| Fetal presentation, cephalic rotation and asynclitism |  | In labour | 
| Vaginal and perineal ruptures after vaginal delivery |  | Hours after delivery | 
| Neonatal outcome |  | Up to 28 days after delivery | 
| Woman's experience of intervention and external cephalic version |  | After intervention, before labour or cesarean section. | 
| Obstetrician's rating of difficulty in performing the external cephalic version |  | After intervention, before labour or cesarean section. | 
| Major complications | Fetal demise, placental abruption, fetal distres (by CTG). | During the study | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pregnancy, Breech Presentation, Version, fetal, Musculoskeletal Manipulations, Medicine, Traditional