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Background . To compare the degree of force applied during external cephalic version, between different patients’ characteristic and outcomes of version. Methods . It is a prospective observational study in a cohort of patients undergoing external cephalic version at or above 36 weeks of gestation. During external cephalic version, the operator wore a pair of pressure-sensing gloves which had ultra-thin piezo-resistive pressure sensors positioned on the palmer surface. Readings from each of the sensors were recorded in real time throughout each version attempt and analyzed by a computer program. The pressure exerted on individual sensors over time, the pressure–time integral (PTI; mmHg s), was calculated for each sensor from the start to the end of each version attempted. The degree of force applied for each attempt (PTI-A) was represented by the sum of pressure–time integrals across all sensors. PTI-A was analyzed in relation to different patients’ characteristics and outcome of version. Results . Ninety-two patients were recruited, 73% of whom had a successful external cephalic version. The median PTI-A of the successful attempt in women who completed version after 1 and 2 attempts were 17,180 and 17,736?mmHg s, respectively. They were significantly lower than that of the women who required 3 or more attempts for a successful version (32,351?mmHg s), as well as the highest PTI-A among all attempts received by women who finally had a failed version (31,638?mmHg s) ( p [ABSTRACT FROM AUTHOR]

To correlate the applied pressure during external cephalic version with the changes in fetal middle cerebral arterial and umbilical arterial flow before and after the procedure.A prospective observational study over a two-year period.External cephalic version was performed in a university hospital.Sixty-nine women with singleton breech-presenting pregnancy at or above 36 weeks of gestation undergoing external cephalic version.During external cephalic version, the operator wore a pair of pressure-sensing gloves which had thin piezo-resistive sensors positioned on the palmar surface. During each version procedure, real-time pressure readings were recorded from all sensors, and then analysed with a computer program. The amount of pressure applied over time was presented by pressure–time integral. The pulsatility indices of both fetal middle cerebral artery and umbilical artery before and after external cephalic version were measured. The changes of pulsatility indices of both middle cerebral artery and umbilical artery were presented as a ratio of the post-external cephalic version pulsatility indices to pre-external cephalic version pulsatility indices, denoted by middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio, respectively. The statistical correlation between pressure–time integral and middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio are analysed using Pearson's correlation test.Changes in pulsatility indices of fetal middle cerebral and umbilical arteries and fetal heart rate after external cephalic version.The overall success rate of external cephalic version was 77%. There was a significant negative correlation between pressure–time integral and both middle cerebral artery pulsatility index ratio (P= 0.001) and umbilical artery pulsatility index ratio (P= 0.012). When women were categorised according to placental site, pressure–time integral was negatively correlated with middle cerebral artery pulsatility index ratio only when the placenta was posteriorly located (P= 0.003), and with umbilical artery pulsatility index ratio only when the placenta was laterally located (P= 0.03).The greater the force applied during external cephalic version, the greater the reduction in pulsatility indices of middle cerebral artery and umbilical artery, indicating an increase in blood flow through these arteries. The increase in cerebral blood flow after external cephalic version is more prominent when the placenta is lying posteriorly, while the increase in umbilical flow is more prominent when the placenta is lying laterally. These findings suggest that the vascular changes probably represent a direct effect of force exerted on the fetal head and the placenta. [ABSTRACT FROM AUTHOR]