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Intrapartum cesarean delivery after successful external cephalic version: a meta-analysis
1Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. lyschan@cuhk.edu.hk
Obstetrics and Gynecology
|July 2, 2004
Summary
Women undergoing external cephalic version (ECV) have a doubled risk of intrapartum cesarean delivery. Pregnancies following successful ECV require closer monitoring and should not be considered typical pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- External cephalic version (ECV) is a procedure to externally manipulate a fetus from a breech to a cephalic presentation.
- The safety and outcomes of pregnancies following successful ECV require careful evaluation.
Purpose of the Study:
- To determine if pregnancies with successful external cephalic version have an increased risk of intrapartum cesarean delivery compared to spontaneous cephalic presentations.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, PubMed, EMBASE, Cochrane Library) for studies published between 1980 and 2002.
- Meta-analysis was employed to combine data from six eligible studies, calculating relative risks (RRs) and 95% confidence intervals (CIs).
Main Results:
- The cesarean delivery rate was significantly higher after successful ECV (27.6%) compared to spontaneous cephalic presentation (12.5%).
- The combined relative risk for intrapartum cesarean delivery was 2.04 (95% CI: 1.43-2.91).
- Increased rates of emergency cesarean delivery were observed for dystocia (RR 2.19) and fetal distress (RR 2.10) in the ECV group.
Conclusions:
- Successful external cephalic version is associated with a two-fold increase in the rate of intrapartum cesarean delivery.
- Pregnancies following successful ECV should be managed with increased vigilance, recognizing they differ from uncomplicated pregnancies.