Outcome of external cephalic version after 36 weeks' gestation without tocolysis

Area of Science:

• Obstetrics
• Maternal-Fetal Medicine
• Perinatal Care

Background:

• External cephalic version (ECV) is an effective method to convert breech presentation to cephalic before labor.
• Despite its efficacy, ECV is underutilized due to concerns about safety and spontaneous versioning.
• Limited data exists, particularly from non-Caucasian populations, regarding ECV outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of external cephalic version (ECV) in a large cohort of women with breech presentation at term.
• To assess the rates of successful version, spontaneous versioning, and perinatal outcomes.
• To provide data on ECV outcomes in a diverse population.

Main Methods:

• A retrospective review of 26 months of data from a dedicated breech clinic in a Dublin teaching hospital.
• All women with breech presentation at 36+ weeks gestation were considered for ECV unless contraindications were present.
• External cephalic version was attempted by a single operator without tocolysis.

Main Results:

• Of 356 attempted ECVs, the overall success rate was 43% (33% nulliparous, 54% multiparous).
• Three perinatal deaths (0.8%) occurred, none related to the ECV procedure.
• Minor complications were infrequent; 93% of successful ECVs resulted in a cephalic presentation at delivery.

Conclusions:

• External cephalic version (ECV) is a safe and effective procedure for term breech presentation.
• Spontaneous version after unsuccessful ECV and reversion after successful ECV are uncommon.
• ECV should be considered more widely for term breech presentations.