Increasing the effectiveness of external cephalic version

The work presented in this thesis focuses on improvement of care for pregnant women with a fetus in breech presentation in order to improve both neonatal and maternal outcome. Nowadays, the dominant mode of delivery for breech is elective caesarean delivery in most countries and is the third most common indication for caesarean delivery. External cephalic version (ECV) is a safe obstetrical procedure that reduces non-cephalic birth and caesarean delivery by approximately 50%. In 2015, the World Health Organization reported on the global overuse of caesarean delivery, and therefore, improving the effectiveness of ECV can highly contribute to the goal to reduce elective caesarean.
To enhance the outcome of ECV, several uterine relaxants are studied and the majority of studies used beta-mimetics. Meta-analysis demonstrated that beta-mimetics can enhance the ECV success rate compared with placebo, however, they have more prominent maternal cardiovascular side effects in comparison with other uterine relaxants and therefore, routine implementation is unlikely. To further increase the uptake of ECV, an individual a priori chance of success estimate can be helpful in counseling women on the treatment options for breech presentation. These problems are all addressed in this thesis, which includes studies on a possible alternative uterine relaxant than beta-mimetics for ECV, determining which uterine relaxant is the best treatment option for ECV, individual prediction of successful ECV and determining whether women may be at increased risk for caesarean delivery after successful ECV compared to women with a spontaneous cephalic presentation.