Predicting the success of external cephalic version with a scoring system. A prospective, two-phase study

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Prediction Models

Background:

• Breech presentation at term complicates delivery and often necessitates interventions.
• External cephalic version (ECV) is a procedure to manually turn the fetus from breech to cephalic presentation.
• Accurate prediction of ECV success is crucial for patient counseling and management.

Purpose of the Study:

• To develop and validate a noninvasive, clinical scoring system for predicting the success of external cephalic version (ECV).
• To identify key clinical parameters that correlate with successful ECV.
• To enable early counseling for women with term breech presentation.

Main Methods:

• A prospective, two-phase clinical study involving 141 external cephalic versions.
• Phase 1: Development of a scoring system using data from 53 ECVs.
• Phase 2: Validation of the scoring system on 88 ECVs using a standard protocol (fetal monitoring, ultrasound, tocolysis).

Main Results:

• Overall ECV success rate was 62.4% across both phases.
• Significant predictors for ECV success identified in Phase 1: head palpable, breech unengagement, symphysis-fundal height, and uterine relaxation.
• The developed scoring system demonstrated high predictive value (Likelihood Ratio > 30 for score ≥ 3, < 1.8 for score ≤ 2).

Conclusions:

• A simple, noninvasive scoring system based on four clinical parameters can predict ECV success.
• This scoring system obviates the need for ultrasound or vaginal examination for prediction.
• Clinical counseling regarding ECV success can be provided immediately after diagnosing breech presentation.