Summary of findings for the main comparison. External cephalic version (ECV) commenced before term versus ECV at term for breech presentation before term.
| External cephalic version (ECV) commenced before term versus ECV at term for breech presentation before term | ||||||
| Population: women with breech presentation before term Settings: 3 trials, 2 multicentre and 1 in Pakistan Intervention: external cephalic version (ECV) commenced before term Comparison: external cephalic version at term | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| External cephalic version at term | External cephalic version (ECV) commenced before term | |||||
| Non‐cephalic presentation at the birth | Study population | RR 0.81 (0.74 to 0.9) | 1906 (3 studies) | ⊕⊕⊕⊕ high | ||
| 523 per 1000 | 424 per 1000 (387 to 471) | |||||
| Moderate | ||||||
| 517 per 1000 | 419 per 1000 (383 to 465) | |||||
| Vaginal cephalic birth not achieved (caesarean section + vaginal breech birth) | Study population | RR 0.9 (0.83 to 0.97) | 1888 (3 studies) | ⊕⊕⊕⊕ high | ||
| 600 per 1000 | 540 per 1000 (498 to 582) | |||||
| Moderate | ||||||
| 633 per 1000 | 570 per 1000 (525 to 614) | |||||
| Caesarean section | Study population | RR 0.92 (0.85 to 1) | 1888 (3 studies) | ⊕⊕⊕⊕ high | ||
| 565 per 1000 | 519 per 1000 (480 to 565) | |||||
| Moderate | ||||||
| 560 per 1000 | 515 per 1000 (476 to 560) | |||||
| Vaginal breech birth | Study population | RR 0.44 (0.25 to 0.78) | 1888 (3 studies) | ⊕⊕⊕⊕ high | ||
| 35 per 1000 | 15 per 1000 (9 to 27) | |||||
| Moderate | ||||||
| 26 per 1000 | 11 per 1000 (6 to 20) | |||||
| Apgar score < 7 at 5 minutes | Study population | RR 1.16 (0.39 to 3.44) | 1759 (2 studies) | ⊕⊕⊝⊝ low1 | ||
| 7 per 1000 | 8 per 1000 (3 to 23) | |||||
| Moderate | ||||||
| 11 per 1000 | 13 per 1000 (4 to 38) | |||||
| Perinatal mortality (Stillbirth or neonatal mortality < 7 days) | Study population | RR 0.23 (0.04 to 1.34) | 1887 (3 studies) | ⊕⊕⊝⊝ low1 | ||
| 5 per 1000 | 1 per 1000 (0 to 7) | |||||
| Moderate | ||||||
| 9 per 1000 | 2 per 1000 (0 to 12) | |||||
| Preterm birth < 37 weeks | Study population | RR 1.51 (1.03 to 2.21) | 1888 (3 studies) | ⊕⊕⊕⊕ high | ||
| 43 per 1000 | 66 per 1000 (45 to 96) | |||||
| Moderate | ||||||
| 44 per 1000 | 66 per 1000 (45 to 97) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Wide 95% CI crossing the line of no effect and low event rate.