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such as female sex&#44; first-born status&#44; breach presentation &#40;after 34 weeks&#8217; gestation&#41;&#44; reduced foetal movement&#44; oligohydramnios or a positive family history of DDH increase the risk of this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Every risk factor for this disease is non-modifiable&#44; except for the presentation of the foetus at birth&#46; External cephalic version &#40;ECV&#41; aims at decreasing the frequency of caesarean sections performed due to breech presentation&#44; thus reducing the maternal and child morbidity and mortality associated with this type of delivery&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> External cephalic version is a relatively easy&#44; safe and inexpensive manoeuvre&#46; After sedating the mother&#44; the obstetrician externally manipulates the foetus by exerting mild pressure on the abdominal wall of the mother to shorten the foetal long axis and achieve its full rotation&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;5</span></a> To guarantee the safety of the foetus&#44; the foetal heart rate is monitored throughout the procedure&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the first days of life&#44; the paediatrician carries out a comprehensive and thorough physical examination of the child that includes an assessment of the hip joints&#46; A meticulous examination is essential&#44; and especial attention should be paid to the examination of the hip in patients with risk factors for DDH&#46; It is important to remember that the earlier the diagnosis is made&#44; the easier and more effective the treatment will be&#44; and the better the final outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;8</span></a> In Spain&#44; imaging tests are not performed routinely&#46; An ultrasound scan of the hip is performed in patients with abnormal findings on physical examination or who have 2 or more risk factors &#40;female sex&#44; breach presentation at birth and&#47;or history of DDH in first-degree relative&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> In patients with normal findings in the physical examination&#44; the best time to do the ultrasound scan is 6 weeks after birth&#44; when the hip is sufficiently mature to avoid false positives yet plastic enough for conservative treatment to be successful&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">External cephalic version changes the presentation of foetuses that have been in a breech position during part of the pregnancy in the last weeks of gestation&#46; However&#44; since these children are finally delivered head-first&#44; they are not considered at risk of DDH and are not included in the current protocol&#46; The aim of our study was to determine the incidence of DDH in patients successfully turned with ECV and assess whether the current protocol should be changed to include patients that were turned successfully&#44; considering them as breech for the purposes of screening&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective cohort study between January 1 and December 31&#44; 2015&#46; We included children born in our hospital that had undergone successful ECV in the last trimester of gestation&#44; and children that were not turned or in who ECV was unsuccessful and had a breech birth as controls&#46; All children underwent an ultrasound scan of the hip at 6 weeks post birth to analyse the incidence of DDH in either group&#46; All parents of the children included in the study were informed about it and signed their consent for participation&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study included a total of 122 patients&#44; 68 &#40;55&#37;&#41; female and 54 &#40;44&#37;&#41; male&#44; with gestational ages ranging between 34 and 41 weeks&#46; They were all products of singleton pregnancies&#44; 108 &#40;89&#37;&#41; born to term and 81 &#40;66&#37;&#41; with first-born status&#46; As for the mode of delivery&#44; 94 &#40;77&#37;&#41; were born by caesarean section &#40;86 due to breach presentation&#44; 4 to prolonged labour&#44; 3 to abnormalities in the ECG tracings and 1 to cephalopelvic disproportion&#41;&#44; and 28 &#40;23&#37;&#41; by normal or instrumental vaginal delivery&#46; Prenatal ultrasound examination found evidence of intrauterine growth restriction in 8 &#40;6&#46;6&#37;&#41;&#44; macrosomia in 8 &#40;6&#46;6&#37;&#41;&#44; oligohydramnios in 3 &#40;2&#46;5&#41; and renal abnormalities in 3 &#40;2&#46;5&#37;&#41;&#46; Nearly 10&#37; of the mothers had a history of gestational diabetes or hypothyroidism&#46; Ten patients had a family history of DDH&#44; 7 of them in a first-degree relative &#40;mother&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">External cephalic version was attempted in 67 patients &#40;55&#37;&#41; between weeks 36 and 40 of gestation&#46; It was successful in 35 cases &#40;52&#46;2&#37; success rate&#41; and failed in 32 &#40;47&#46;8&#37;&#41;&#46; Of the 35 patients that were turned&#44; 28 were born in a normal vaginal delivery and 7 by caesarean section &#40;4 due to prolonged labour&#44; 2 to risk of foetal distress&#44; 1 to cephalopelvic disproportion&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Ultrasound examination of the hip detected DDH in 14 patients&#58; 11 who had not been turned and were born breech &#40;ECV had been attempted and unsuccessful in 6&#41; and 3 successfully turned and born with a cephalic presentation &#40;2 female foetuses turned at 38 weeks&#8217; gestation and 1 male foetus turned at 37 weeks&#8217; gestation&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents a flowchart with the number of patients included in each group under study with the corresponding percentages of DDH&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The characteristics of the 14 infants with DDH confirmed by ultrasound were the following&#58; 9 were female and 5 male&#44; 11 were first-born children&#44; 2 were large for gestational age&#44; 3 had a history of DDH in first-degree relatives&#44; 1 had associated torticollis and 1 had a history of intrauterine growth restriction&#46; The physical examination had been abnormal in 5 and normal in the remaining 9 &#40;including the 3 patients in whom ECV was successful&#41;&#46; We ought to note that in one patient&#44; the physical examination was abnormal but the ultrasound scan found no evidence of DDH&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">There were different reasons for ordering an ultrasound scan of the hip in the 14 patients with DDH&#46; Six met the criteria established in the current DDH screening protocol of our hospital&#44; 5 had abnormal findings in the physical examination&#44; and in the remaining 3&#44; the scan was ordered with the objective pursued in this study&#58; to determine the incidence of DDH in infants in whom ECV had been successful with a normal physical examination and no other risk factors&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Developmental dysplasia of the hip is a disease that requires early diagnosis and treatment on account of the significant consequences that result from delays in treatment&#46; This disease has been associated with various risk factors&#44; including female sex&#44; first-born status&#44; breech presentation after 34 weeks&#8217; gestation&#44; oligohydramnios or a history of DDH in first-degree relatives&#46; In our study&#44; we found evidence of the association of DDH with female sex&#44; breech presentation and positive family history&#46; The disease was also associated with other causes of a reduced intrauterine space that have an impact on hip development in addition to breech presentation&#44; such as macrosomia or oligohydramnios&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In recent years&#44; there have been changes in the practice of obstetrics&#46; Caesarean section is becoming the routine mode of delivery in breech births&#44; as it is associated with a reduction in perinatal mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> The introduction of ECV has succeeded in reducing the number of foetuses with a breech presentation and therefore the frequency of caesarean delivery and its associated risks&#46; However&#44; there are very few studies that assess its impact in relation to DDH&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> The modification of the foetal presentation is beneficial for both mother and child&#44; but we need to investigate its potential impact on the newborn&#39;s hip&#46; Two methods are currently available for the early diagnosis of this disease&#58; routine physical examination and routine ultrasound examination in children with 2 or more risk factors&#46; This raises the question whether an ultrasound examination should be ordered in infants whose physical examination is normal and who do not strictly meet the criterion of breech birth because they were born in a normal vaginal delivery following successful ECV&#46; Considering the pathophysiology of DDH&#44; it would be reasonable to hypothesise that these children are at lower risk of DDH compared to children who are in a breech position until birth&#44; and that this risk would decrease the longer the time elapsed between ECV and delivery&#46; In any case&#44; it would also be logical to assume that having temporarily been in a breech position would increase the likelihood of DDH in these children compared to children with a strictly cephalic presentation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The overall incidence of this disease in Spain is 4&#46;3&#37;&#44; based on data from two studies that included 40&#44;243 newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">12&#44;13</span></a> To date&#44; no studies have assessed the impact of ECV on DDH in Spanish children&#46; However&#44; a study conducted in the Netherlands found a prevalence of DDH of 2&#46;8&#37; in children that had a cephalic birth after successful ECV&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In our study&#44; there were 35 children that had been turned <span class="elsevierStyleItalic">in utero</span> and had cephalic births and a normal neonatal physical examination&#46; They all underwent ultrasound examination &#40;outside of the current protocol&#41;&#44; which detected DDH in 3 &#40;8&#46;5&#37;&#41;&#46; If we had not included these children in the DDH screening protocol&#44; their diagnosis and treatment would have been delayed&#44; probably until they started walking&#44; at which point DDH would have had irreversible consequences&#46; Therefore&#44; we should reassess whether we should not consider infants in whom ECV was successful breech for the purpose of DDH screening&#46; Successful ECV offers significant advantages&#46; From a clinical standpoint&#44; it prevents the morbidity associated with surgical intervention &#40;caesarean section&#41;&#44; and from an economic standpoint&#44; it decreases the mean length of stay following birth &#40;2 days for normal vaginal delivery vs 4&#8211;5 days for caesarean delivery&#41;&#46; However&#44; while ECV reduces the risk of DDH associated with breech presentation&#44; there is a risk that DDH will go undetected in children successfully turned with ECV if they are excluded in the screening protocol&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As for the limitations of our study&#44; we ought to highlight that the sample size was small&#44; resulting in a reduced power to find statistically significant results&#46; We need to continue this line of research in order to find significant results that can be applied to clinical practice&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The results of our study supported our working hypothesis&#58; foetuses who were in the breech position during gestation and successfully turned to the cephalic position have a risk of developing DDH that&#44; while lower than that of those with a breech presentation at birth&#44; is still significant&#44; and therefore should not be excluded from DDH screening&#46; Thus&#44; we should continue investigating the association between DDH and this risk factor&#46; Furthermore&#44; or results evinced the need of forming multidisciplinary teams where obstetricians&#44; paediatricians and paediatric radiologists could work collaboratively with the purpose of adapting advances in the field of obstetrics to the field of paediatrics&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Developmental dysplasia of the hip"
            1 => "External cephalic version"
            2 => "Breech presentation"
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            0 => "Displasia del desarrollo de la cadera"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Developmental dysplasia of the hip &#40;DDH&#41; refers to the spectrum of abnormalities of maturation and development of the hip&#46; Breech presentation is associated with DDH&#46; This risk factor can be modified by external cephalic version &#40;ECV&#41;&#46; The aim of this study is to evaluate the incidence of DDH in patients who successfully underwent ECV&#44; as well as to evaluate need for these children &#40;breech for a period during gestation&#41; to be included in the DDH screening protocol&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort study was conducted in the Hospital Universitario de Vigo from January 1&#44; 2015 to December 31&#44; 2015&#46; It included children born in cephalic presentation after a successful ECV&#44; as well as children born in breech presentation&#46; They all were screened for DDH by ultrasound examination of the hip&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Out of a total of 122 newborns included in the study&#44; ECV was attempted on 67 &#40;54&#46;9&#37;&#41;&#44; of which 35 &#40;52&#46;2&#37;&#41; were successful&#46; Out of the 14 children diagnosed with DDH&#44; 3 of those born in cephalic presentation after a successful ECV were found to be normal on physical examination&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Successful ECV is associated with a lower incidence of DDH as regards breech presentation&#46; However&#44; these patients should be included in the DDH screening protocol for the early detection of this disorder&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La displasia del desarrollo de la cadera &#40;DDC&#41; engloba un espectro de anomal&#237;as que afecta a la maduraci&#243;n y desarrollo de la cadera&#46; La presentaci&#243;n pod&#225;lica es uno de los factores de riesgo asociado a esta patolog&#237;a y puede ser modificada en las &#250;ltimas semanas de gestaci&#243;n mediante la versi&#243;n cef&#225;lica externa &#40;VCE&#41;&#46; El objetivo de nuestro trabajo es determinar la incidencia de DDC en pacientes sometidos a una VCE exitosa&#44; as&#237; como valorar la necesidad de incluir a estos ni&#241;os &#40;pod&#225;licos durante gran parte de la gestaci&#243;n&#41; en el protocolo de cribado de DDC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo realizado en el Hospital Universitario de Vigo entre el 1 de enero y el 31 de diciembre del 2015&#46; Participaron ni&#241;os sometidos a VCE y ni&#241;os pod&#225;licos no sometidos a VCE&#46; A todos ellos se les realiz&#243; una ecograf&#237;a de cadera para estudiar la incidencia de DDC en ambos grupos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 122 pacientes&#46; Se intent&#243; realizar VCE en 67 &#40;54&#44;9&#37;&#41; siendo exitosa en 35 &#40;52&#44;2&#37;&#41;&#46; De los 122 ni&#241;os&#58; 14 fueron diagnosticados de DDC mediante ecograf&#237;a&#46; Tres &#40;8&#44;5&#37;&#41; de los ni&#241;os con DDC nacieron en presentaci&#243;n cef&#225;lica tras VCE exitosa con exploraci&#243;n f&#237;sica de caderas normal al nacimiento&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La VCE reduce el riesgo de DDC con respecto a la presentaci&#243;n pod&#225;lica pero de no incluir a los ni&#241;os versionados con &#233;xito en el protocolo de cribado de DDC&#44; corremos el riesgo de no detectar precozmente esta patolog&#237;a&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Sarmiento Carrera N&#44; Gonz&#225;lez Colmenero E&#44; V&#225;zquez Castelo JL&#44; Concheiro Guis&#225;n A&#44; Couceiro Naveira E&#44; Fern&#225;ndez Lorenzo JR&#46; Riesgo de displasia del desarrollo de la cadera en pacientes sometidos a versi&#243;n cef&#225;lica externa&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;88&#58;136&#8211;139&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the patients included in each study group and percentage of DDH in each&#46; Total patients &#40;breech presentation&#41; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>122&#46;</p>"
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                      "titulo" => "Displasia cong&#233;nita de la cadera"
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                            0 => "A&#46;J&#46; Fern&#225;ndez Arroyo"
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Original Article
Risk of developmental dysplasia of the hip in patients subjected to the external cephalic version
Riesgo de displasia del desarrollo de la cadera en pacientes sometidos a versión cefálica externa
Nerea Sarmiento Carreraa,
Corresponding author
, Eva González Colmeneroa, José Luis Vázquez Castelob, Ana Concheiro Guisána, Emilio Couceiro Naveirac, José Ramón Fernández Lorenzoa
a Servicio de Pediatría, Hospital Álvaro Cunqueiro, Vigo, Spain
b Servicio de Radiología, Hospital Álvaro Cunqueiro, Vigo, Spain
c Servicio de Obstetricia y Ginecología, Hospital Álvaro Cunqueiro, Vigo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Developmental dysplasia of the hip &#40;DDH&#41; is a spectrum of anomalies that affect the maturation of the hip in the newborn in which the femoral head and acetabulum have an abnormal relationship and development&#46; In the first weeks of life&#44; newborns may have a physiological laxity in the hip joint and immaturity of the acetabulum that resolves spontaneously and with no sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> However&#44; uncorrected DDH is associated with significant long-term comorbidities&#44; such as gait abnormalities&#44; chronic pain or degenerative disease of the coxofemoral joint&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1&#44;2</span></a> Certain factors&#44; such as female sex&#44; first-born status&#44; breach presentation &#40;after 34 weeks&#8217; gestation&#41;&#44; reduced foetal movement&#44; oligohydramnios or a positive family history of DDH increase the risk of this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Every risk factor for this disease is non-modifiable&#44; except for the presentation of the foetus at birth&#46; External cephalic version &#40;ECV&#41; aims at decreasing the frequency of caesarean sections performed due to breech presentation&#44; thus reducing the maternal and child morbidity and mortality associated with this type of delivery&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> External cephalic version is a relatively easy&#44; safe and inexpensive manoeuvre&#46; After sedating the mother&#44; the obstetrician externally manipulates the foetus by exerting mild pressure on the abdominal wall of the mother to shorten the foetal long axis and achieve its full rotation&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;5</span></a> To guarantee the safety of the foetus&#44; the foetal heart rate is monitored throughout the procedure&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the first days of life&#44; the paediatrician carries out a comprehensive and thorough physical examination of the child that includes an assessment of the hip joints&#46; A meticulous examination is essential&#44; and especial attention should be paid to the examination of the hip in patients with risk factors for DDH&#46; It is important to remember that the earlier the diagnosis is made&#44; the easier and more effective the treatment will be&#44; and the better the final outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6&#8211;8</span></a> In Spain&#44; imaging tests are not performed routinely&#46; An ultrasound scan of the hip is performed in patients with abnormal findings on physical examination or who have 2 or more risk factors &#40;female sex&#44; breach presentation at birth and&#47;or history of DDH in first-degree relative&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> In patients with normal findings in the physical examination&#44; the best time to do the ultrasound scan is 6 weeks after birth&#44; when the hip is sufficiently mature to avoid false positives yet plastic enough for conservative treatment to be successful&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">External cephalic version changes the presentation of foetuses that have been in a breech position during part of the pregnancy in the last weeks of gestation&#46; However&#44; since these children are finally delivered head-first&#44; they are not considered at risk of DDH and are not included in the current protocol&#46; The aim of our study was to determine the incidence of DDH in patients successfully turned with ECV and assess whether the current protocol should be changed to include patients that were turned successfully&#44; considering them as breech for the purposes of screening&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective cohort study between January 1 and December 31&#44; 2015&#46; We included children born in our hospital that had undergone successful ECV in the last trimester of gestation&#44; and children that were not turned or in who ECV was unsuccessful and had a breech birth as controls&#46; All children underwent an ultrasound scan of the hip at 6 weeks post birth to analyse the incidence of DDH in either group&#46; All parents of the children included in the study were informed about it and signed their consent for participation&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study included a total of 122 patients&#44; 68 &#40;55&#37;&#41; female and 54 &#40;44&#37;&#41; male&#44; with gestational ages ranging between 34 and 41 weeks&#46; They were all products of singleton pregnancies&#44; 108 &#40;89&#37;&#41; born to term and 81 &#40;66&#37;&#41; with first-born status&#46; As for the mode of delivery&#44; 94 &#40;77&#37;&#41; were born by caesarean section &#40;86 due to breach presentation&#44; 4 to prolonged labour&#44; 3 to abnormalities in the ECG tracings and 1 to cephalopelvic disproportion&#41;&#44; and 28 &#40;23&#37;&#41; by normal or instrumental vaginal delivery&#46; Prenatal ultrasound examination found evidence of intrauterine growth restriction in 8 &#40;6&#46;6&#37;&#41;&#44; macrosomia in 8 &#40;6&#46;6&#37;&#41;&#44; oligohydramnios in 3 &#40;2&#46;5&#41; and renal abnormalities in 3 &#40;2&#46;5&#37;&#41;&#46; Nearly 10&#37; of the mothers had a history of gestational diabetes or hypothyroidism&#46; Ten patients had a family history of DDH&#44; 7 of them in a first-degree relative &#40;mother&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">External cephalic version was attempted in 67 patients &#40;55&#37;&#41; between weeks 36 and 40 of gestation&#46; It was successful in 35 cases &#40;52&#46;2&#37; success rate&#41; and failed in 32 &#40;47&#46;8&#37;&#41;&#46; Of the 35 patients that were turned&#44; 28 were born in a normal vaginal delivery and 7 by caesarean section &#40;4 due to prolonged labour&#44; 2 to risk of foetal distress&#44; 1 to cephalopelvic disproportion&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Ultrasound examination of the hip detected DDH in 14 patients&#58; 11 who had not been turned and were born breech &#40;ECV had been attempted and unsuccessful in 6&#41; and 3 successfully turned and born with a cephalic presentation &#40;2 female foetuses turned at 38 weeks&#8217; gestation and 1 male foetus turned at 37 weeks&#8217; gestation&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents a flowchart with the number of patients included in each group under study with the corresponding percentages of DDH&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The characteristics of the 14 infants with DDH confirmed by ultrasound were the following&#58; 9 were female and 5 male&#44; 11 were first-born children&#44; 2 were large for gestational age&#44; 3 had a history of DDH in first-degree relatives&#44; 1 had associated torticollis and 1 had a history of intrauterine growth restriction&#46; The physical examination had been abnormal in 5 and normal in the remaining 9 &#40;including the 3 patients in whom ECV was successful&#41;&#46; We ought to note that in one patient&#44; the physical examination was abnormal but the ultrasound scan found no evidence of DDH&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">There were different reasons for ordering an ultrasound scan of the hip in the 14 patients with DDH&#46; Six met the criteria established in the current DDH screening protocol of our hospital&#44; 5 had abnormal findings in the physical examination&#44; and in the remaining 3&#44; the scan was ordered with the objective pursued in this study&#58; to determine the incidence of DDH in infants in whom ECV had been successful with a normal physical examination and no other risk factors&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Developmental dysplasia of the hip is a disease that requires early diagnosis and treatment on account of the significant consequences that result from delays in treatment&#46; This disease has been associated with various risk factors&#44; including female sex&#44; first-born status&#44; breech presentation after 34 weeks&#8217; gestation&#44; oligohydramnios or a history of DDH in first-degree relatives&#46; In our study&#44; we found evidence of the association of DDH with female sex&#44; breech presentation and positive family history&#46; The disease was also associated with other causes of a reduced intrauterine space that have an impact on hip development in addition to breech presentation&#44; such as macrosomia or oligohydramnios&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In recent years&#44; there have been changes in the practice of obstetrics&#46; Caesarean section is becoming the routine mode of delivery in breech births&#44; as it is associated with a reduction in perinatal mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> The introduction of ECV has succeeded in reducing the number of foetuses with a breech presentation and therefore the frequency of caesarean delivery and its associated risks&#46; However&#44; there are very few studies that assess its impact in relation to DDH&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> The modification of the foetal presentation is beneficial for both mother and child&#44; but we need to investigate its potential impact on the newborn&#39;s hip&#46; Two methods are currently available for the early diagnosis of this disease&#58; routine physical examination and routine ultrasound examination in children with 2 or more risk factors&#46; This raises the question whether an ultrasound examination should be ordered in infants whose physical examination is normal and who do not strictly meet the criterion of breech birth because they were born in a normal vaginal delivery following successful ECV&#46; Considering the pathophysiology of DDH&#44; it would be reasonable to hypothesise that these children are at lower risk of DDH compared to children who are in a breech position until birth&#44; and that this risk would decrease the longer the time elapsed between ECV and delivery&#46; In any case&#44; it would also be logical to assume that having temporarily been in a breech position would increase the likelihood of DDH in these children compared to children with a strictly cephalic presentation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The overall incidence of this disease in Spain is 4&#46;3&#37;&#44; based on data from two studies that included 40&#44;243 newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">12&#44;13</span></a> To date&#44; no studies have assessed the impact of ECV on DDH in Spanish children&#46; However&#44; a study conducted in the Netherlands found a prevalence of DDH of 2&#46;8&#37; in children that had a cephalic birth after successful ECV&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In our study&#44; there were 35 children that had been turned <span class="elsevierStyleItalic">in utero</span> and had cephalic births and a normal neonatal physical examination&#46; They all underwent ultrasound examination &#40;outside of the current protocol&#41;&#44; which detected DDH in 3 &#40;8&#46;5&#37;&#41;&#46; If we had not included these children in the DDH screening protocol&#44; their diagnosis and treatment would have been delayed&#44; probably until they started walking&#44; at which point DDH would have had irreversible consequences&#46; Therefore&#44; we should reassess whether we should not consider infants in whom ECV was successful breech for the purpose of DDH screening&#46; Successful ECV offers significant advantages&#46; From a clinical standpoint&#44; it prevents the morbidity associated with surgical intervention &#40;caesarean section&#41;&#44; and from an economic standpoint&#44; it decreases the mean length of stay following birth &#40;2 days for normal vaginal delivery vs 4&#8211;5 days for caesarean delivery&#41;&#46; However&#44; while ECV reduces the risk of DDH associated with breech presentation&#44; there is a risk that DDH will go undetected in children successfully turned with ECV if they are excluded in the screening protocol&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As for the limitations of our study&#44; we ought to highlight that the sample size was small&#44; resulting in a reduced power to find statistically significant results&#46; We need to continue this line of research in order to find significant results that can be applied to clinical practice&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The results of our study supported our working hypothesis&#58; foetuses who were in the breech position during gestation and successfully turned to the cephalic position have a risk of developing DDH that&#44; while lower than that of those with a breech presentation at birth&#44; is still significant&#44; and therefore should not be excluded from DDH screening&#46; Thus&#44; we should continue investigating the association between DDH and this risk factor&#46; Furthermore&#44; or results evinced the need of forming multidisciplinary teams where obstetricians&#44; paediatricians and paediatric radiologists could work collaboratively with the purpose of adapting advances in the field of obstetrics to the field of paediatrics&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "palabras" => array:3 [
            0 => "Developmental dysplasia of the hip"
            1 => "External cephalic version"
            2 => "Breech presentation"
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            0 => "Displasia del desarrollo de la cadera"
            1 => "Versi&#243;n cef&#225;lica externa"
            2 => "Presentaci&#243;n pod&#225;lica"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Developmental dysplasia of the hip &#40;DDH&#41; refers to the spectrum of abnormalities of maturation and development of the hip&#46; Breech presentation is associated with DDH&#46; This risk factor can be modified by external cephalic version &#40;ECV&#41;&#46; The aim of this study is to evaluate the incidence of DDH in patients who successfully underwent ECV&#44; as well as to evaluate need for these children &#40;breech for a period during gestation&#41; to be included in the DDH screening protocol&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort study was conducted in the Hospital Universitario de Vigo from January 1&#44; 2015 to December 31&#44; 2015&#46; It included children born in cephalic presentation after a successful ECV&#44; as well as children born in breech presentation&#46; They all were screened for DDH by ultrasound examination of the hip&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Out of a total of 122 newborns included in the study&#44; ECV was attempted on 67 &#40;54&#46;9&#37;&#41;&#44; of which 35 &#40;52&#46;2&#37;&#41; were successful&#46; Out of the 14 children diagnosed with DDH&#44; 3 of those born in cephalic presentation after a successful ECV were found to be normal on physical examination&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Successful ECV is associated with a lower incidence of DDH as regards breech presentation&#46; However&#44; these patients should be included in the DDH screening protocol for the early detection of this disorder&#46;</p></span>"
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            "titulo" => "Material and methods"
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La displasia del desarrollo de la cadera &#40;DDC&#41; engloba un espectro de anomal&#237;as que afecta a la maduraci&#243;n y desarrollo de la cadera&#46; La presentaci&#243;n pod&#225;lica es uno de los factores de riesgo asociado a esta patolog&#237;a y puede ser modificada en las &#250;ltimas semanas de gestaci&#243;n mediante la versi&#243;n cef&#225;lica externa &#40;VCE&#41;&#46; El objetivo de nuestro trabajo es determinar la incidencia de DDC en pacientes sometidos a una VCE exitosa&#44; as&#237; como valorar la necesidad de incluir a estos ni&#241;os &#40;pod&#225;licos durante gran parte de la gestaci&#243;n&#41; en el protocolo de cribado de DDC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo realizado en el Hospital Universitario de Vigo entre el 1 de enero y el 31 de diciembre del 2015&#46; Participaron ni&#241;os sometidos a VCE y ni&#241;os pod&#225;licos no sometidos a VCE&#46; A todos ellos se les realiz&#243; una ecograf&#237;a de cadera para estudiar la incidencia de DDC en ambos grupos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 122 pacientes&#46; Se intent&#243; realizar VCE en 67 &#40;54&#44;9&#37;&#41; siendo exitosa en 35 &#40;52&#44;2&#37;&#41;&#46; De los 122 ni&#241;os&#58; 14 fueron diagnosticados de DDC mediante ecograf&#237;a&#46; Tres &#40;8&#44;5&#37;&#41; de los ni&#241;os con DDC nacieron en presentaci&#243;n cef&#225;lica tras VCE exitosa con exploraci&#243;n f&#237;sica de caderas normal al nacimiento&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La VCE reduce el riesgo de DDC con respecto a la presentaci&#243;n pod&#225;lica pero de no incluir a los ni&#241;os versionados con &#233;xito en el protocolo de cribado de DDC&#44; corremos el riesgo de no detectar precozmente esta patolog&#237;a&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Sarmiento Carrera N&#44; Gonz&#225;lez Colmenero E&#44; V&#225;zquez Castelo JL&#44; Concheiro Guis&#225;n A&#44; Couceiro Naveira E&#44; Fern&#225;ndez Lorenzo JR&#46; Riesgo de displasia del desarrollo de la cadera en pacientes sometidos a versi&#243;n cef&#225;lica externa&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;88&#58;136&#8211;139&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the patients included in each study group and percentage of DDH in each&#46; Total patients &#40;breech presentation&#41; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>122&#46;</p>"
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Article information
ISSN: 23412879
Original language: English
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2024 April 68 36 104
2024 March 69 32 101
2024 February 70 24 94
2024 January 86 27 113
2023 December 90 26 116
2023 November 88 26 114
2023 October 53 23 76
2023 September 37 21 58
2023 August 44 23 67
2023 July 35 30 65
2023 June 49 31 80
2023 May 57 22 79
2023 April 42 16 58
2023 March 83 36 119
2023 February 62 24 86
2023 January 39 19 58
2022 December 81 35 116
2022 November 68 35 103
2022 October 109 44 153
2022 September 45 41 86
2022 August 52 59 111
2022 July 43 38 81
2022 June 80 39 119
2022 May 55 44 99
2022 April 58 46 104
2022 March 77 52 129
2022 February 78 29 107
2022 January 99 36 135
2021 December 89 41 130
2021 November 60 44 104
2021 October 93 93 186
2021 September 42 34 76
2021 August 53 56 109
2021 July 43 42 85
2021 June 55 52 107
2021 May 52 53 105
2021 April 117 82 199
2021 March 77 37 114
2021 February 55 19 74
2021 January 75 42 117
2020 December 75 44 119
2020 November 64 29 93
2020 October 46 19 65
2020 September 57 31 88
2020 August 57 20 77
2020 July 64 14 78
2020 June 60 16 76
2020 May 55 31 86
2020 April 28 20 48
2020 March 51 33 84
2020 February 28 30 58
2020 January 33 16 49
2019 December 76 24 100
2019 November 55 21 76
2019 October 45 18 63
2019 September 54 44 98
2019 August 60 28 88
2019 July 49 32 81
2019 June 53 24 77
2019 May 56 46 102
2019 April 73 30 103
2019 March 56 19 75
2019 February 39 19 58
2019 January 42 26 68
2018 December 49 29 78
2018 November 85 27 112
2018 October 117 29 146
2018 September 46 25 71
2018 August 2 0 2
2018 July 3 0 3
2018 June 2 0 2
2018 May 13 0 13
2018 April 34 0 34
2018 February 0 23 23
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?