TOP 6 - External Cephalic Version and Developmental Dysplasia of the Hip: Impact of Timing and Success

Publication Number: 3790.TOP 6

Angela C. Judd, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States; Abhinav Parikh, NewYork-Presbyterian Komansky Children’s Hospital, Brooklyn, NY, United States

Background: Developmental dysplasia of the hip (DDH) occurs due to abnormal development of the acetabulum and femoral head when improper fetal or postnatal positioning hinders proper growth. Ultrasound (US) screening for DDH is recommended at six weeks of life for term infants with family history of DDH, concerning physical exam, or breech position. Recent research has shown that breech position at later gestational ages and longer duration of breech positioning increases the likelihood of DDH 1.
Fetal breech positioning is also associated with other gestational parent (maternal) and neonatal morbidity and mortality during vaginal delivery so cesarean section is recommended. An option to avoid cesarean section is external cephalic version (ECV) during which the infant is manually turned to cephalic position. The American College of Obstetrics and Gynecology recommends this procedure be done at 37 weeks due to the risk of need for emergent delivery.

Even infants who had successful ECV show increased risk of DDH. When comparing successful versus unsuccessful ECV some studies have shown that successful ECV is a protective factor for DDH and others have shown no difference 2,3,4.

Objective: The objective of this study is to explore the relationship between timing of ECV, success of the procedure and risk of DDH.
Hypothesis: If a retrospective chart review exploring the relationship between timing and success of ECV with alpha angle and acetabular coverage on screening US then both earlier ECV and successful ECV will be individually associated with higher alpha angle and increased coverage.

Design/Methods: Retrospective chart review of gestational parent and neonate with history of attempted ECV during pregnancy found via SlicerDicer procedure code and linked gestational parent-child charts.
Completed: Review of all epic charts with ECV procedure code. Record whether procedure was successful: cephalic position obtained and delivered cephalic. Unsuccessful: remains in breech position and delivered breech. Review of infant's chart: result of DDH screening US (alpha angle and acetabular coverage). Initial data analysis showed 43% of infants with unsuccessful ECV had abnormal screening ultrasound versus 0% of infants with successful ECV.
November-December: Alpha angle and acetabular coverage will be compared between successful and unsuccessful ECV as well as timing of ECV. Quantitative data will be analyzed by statistician using regression, t-test, ANOVA, MANOVA as indicated. Possible confounding variables such as weight, amniotic fluid index, age of mother, ect will be included in analysis.

DDH Ultrasound Screening Results for Infants with Successful versus Unsuccessful ECV
Initial data analysis showed 43% of infants with a history of unsuccessful ECV had abnormal developmental dysplasia of the hip ultrasound screening versus 0% of infants with a history of successful ECV.