Applying the Newman-Peacock Prognostic System to a Portuguese Obstetrical Population - A Useful Tool?

Abstract

Background External cephalic version (ECV) is a maneuver that enables the rotation of the non-cephalic fetus to a cephalic presentation. The Newman-Peacock (NP) index, which was proposed by Newman et al. in a study published in 1993, was described as a prediction tool of the success of this procedure; it was validated in a North-American population, and three prognostic groups were identified.

Purpose To evaluate the value of the NP score for the prediction of a successful ECV in a Portuguese obstetrical population, and to evaluate maternal and fetal safety.

Methods We present an observational study conducted from 1997–2016 with pregnant women at 36–38 weeks of pregnancy who were candidates for external cephalic version in our department. Demographic and obstetrical data were collected, including the parameters included in the NP index (parity, cervical dilatation, estimated fetal weight, placental location and fetal station). The calculation of the NP score was performed, and the percentages of success were compared among the three prognostic groups and with the original study by Newman et al. The performance of the score was determined using the Student t-test, the Chi-squared test, and a receiver operating characteristic (ROC) curve.

Results In total, 337 women were included. The overall success rate was of 43.6%. The univariate analysis revealed that multiparity, posterior placentation and a less engaged fetus were factors that favored a successful maneuver (p < 0.05). Moreover, a higher amniotic fluid index was also a relevant predictive factor (p < 0.05). The Newman-Peacock score had a poorer performance in our population compared with that of the sample of the original study, but we still found a positive relationship between higher scores and higher prediction of success (p < 0.001). No fetal or maternal morbidities were registered.

Conclusions The Newman-Peacock score had a poorer performance among our population compared to its performance in the original study, but the results suggest that this score is still a useful tool to guide our clinical practice and counsel the candidate regarding ECV.

Resumo

Âmbito A versão cefálica externa (VCE) é uma manobra que permite a obtenção de uma apresentação cefálica em fetos não-cefálicos. O índice de Newman-Peacock (NP), proposto por Newman et al em um estudo publicado em 1993, foi descrito como preditivo do sucesso desta manobra; ele foi validado numa população norte-americana, e três grupos de prognóstico diferentes foram identificados.

Objectivo Avaliação do valor preditivo do índice de NP para o sucesso da VCE numa população obstétrica portuguesa, bem como da segurança materno-fetal.

Métodos Foi realizado no nosso departamento um estudo observacional entre 1997–2016 em grávidas candidatas a VCE entre as 36 e as 38 semanas de gravidez. Foram colhidos dados demográficos e obstétricos, incluindo os parâmetros incluídos no índice de NP (a paridade, a dilatação cervical, a estimativa do peso fetal, a localização placentária e a altura da apresentação fetal). A pontuação das candidatas de acordo com o índice de NP e a percentagem de sucesso da VCE foram comparadas entre os três grupos de prognóstico, e também com o estudo original de Newman et al. O desempenho deste índice foi avaliado recorrendo aos testes t de Student, qui-quadrado e curva receiver operating characteristic (ROC).

Resultados Foram incluídas 337 mulheres. A taxa de sucesso da manobra foi de 43,6%. A análise univariada mostrou que a multiparidade, a placentação posterior e uma apresentação não encravada foram favoráveis para o sucesso do procedimento (p < 0,05). Adicionalmente, um maior índice de líquido amniótico revelou-se também como um fator preditivo significativo (p < 0,05). O índice de Newman-Peacock apresentou um desempenho inferior na nossa população comparativamente à sua descrição original, porém continuou a verificar-se uma relação positiva entre pontuações mais elevadas e uma maior percentagem de sucesso (p < 0,001).

Conclusão No nosso trabalho, o índice de Newman-Peacock apresentou um valor preditivo inferior comparativamente ao estudo original, porém os resultados mostram que se mantém uma ferramenta com utilidade para a prática clínica e para o aconselhamento das candidatas a versão cefálica externa.

Keywords

Newman-Peacock prognostic system score - external cephalic version - breech presentation - vaginal delivery

Palavras-chave

modelo de prognóstico Newman-Peacock - versão cefálica externa - apresentação pélvica - parto vaginal

Contribution to Authorship

Rita Silva Batista participated in the conception and design of the study, acquisition of data, analysis and interpretation of data, literature search, writing and editing.

Nuno Clode participated in the conception and design of the study, acquisition of data, analysis and interpretation of data, and revision of important intellectual content.

• References

• 1 Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. ; Term Breech Trial Collaborative Group. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000; 356 (9239): 1375-1383
• 2 Beuckens A, Rijnders M, Verburgt-Doeleman GH, Rijninks-van Driel GC, Thorpe J, Hutton EK. An observational study of the success and complications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwives. BJOG 2016; 123 (03) 415-423
• 3 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 161: external cephalic version. Obstet Gynecol 2016; 127 (02) e54-e61
• 4 Newman RB, Peacock BS, VanDorsten JP, Hunt HH. Predicting success of external cephalic version. Am J Obstet Gynecol 1993; 169 (2 Pt 1): 245-249 , discussion 249–250
• 5 Aisenbrey GA, Catanzarite VA, Nelson C. External cephalic version: predictors of success. Obstet Gynecol 1999; 94 (5 Pt 1): 783-786
• 6 Kok M, van der Steeg JW, van der Post JA, Mol BW. Prediction of success of external cephalic version after 36 weeks. Am J Perinatol 2011; 28 (02) 103-110
• 7 Mowat A, Gardener G. Predictors of successful external cephalic version in an Australian maternity hospital. Aust N Z J Obstet Gynaecol 2014; 54 (01) 59-63
• 8 Ebner F, Friedl TW, Leinert E. , et al. Predictors for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet 2016; 293 (04) 749-755
• 9 Tasnim N, Mahmud G, Javaid K, Malhotra N, Puri R. GNK-PIMS Score: a predictive model for success of external cephalic version. J South Asian Fed Obstet Gynaecol 2012; 4 (02) 99-102
• 10 Hutton EK, Hofmeyr GJ, Dowswell T. External cephalic version for breech presentation before term. Cochrane Database Syst Rev 2015; (07) CD000084
• 11 Indraccolo U, Graziani C, Di Iorio R, Corona G, Bonito M, Indraccolo SR. External cephalic version for singleton breech presentation: proposal of a practical check-list for obstetricians. Eur Rev Med Pharmacol Sci 2015; 19 (13) 2340-2353
• 12 Burgos J, Melchor JC, Pijoán JI, Cobos P, Fernández-Llebrez L, Martínez-Astorquiza T. A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term. Int J Gynaecol Obstet 2011; 112 (01) 48-51
• 13 Ben-Meir A, Erez Y, Sela HY, Shveiky D, Tsafrir A, Ezra Y. Prognostic parameters for successful external cephalic version. J Matern Fetal Neonatal Med 2008; 21 (09) 660-662
• 14 Tasnim N, Mahmud G, Khurshid M. External cephalic version with salbutamol - success rate and predictors of success. J Coll Physicians Surg Pak 2009; 19 (02) 91-94
• 15 Velzel J, de Hundt M, Mulder FM. , et al. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 195: 160-167
• 16 Wong WM, Lao TT, Liu KL. Predicting the success of external cephalic version with a scoring system. A prospective, two-phase study. J Reprod Med 2000; 45 (03) 201-206
• 17 Burgos J, Cobos P, Rodriguez L. , et al. Clinical score for the outcome of external cephalic version: a two-phase prospective study. Aust N Z J Obstet Gynaecol 2012; 52 (01) 59-61