Introducing external cephalic version in a Malaysian setting

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Perinatal Care

Background:

• Malpresentation of the fetus at term complicates approximately 3-4% of pregnancies.
• External cephalic version (ECV) is a procedure to manually turn a fetus from a non-vertex presentation to a vertex presentation before labor.
• Routine ECV for malpresenting fetuses at term aims to increase vaginal birth rates and reduce cesarean sections.

Purpose of the Study:

• To evaluate the outcomes of external cephalic version (ECV) as a routine management strategy for fetuses presenting with malpresentation at term.
• To identify characteristics associated with the success or failure of ECV.
• To assess maternal and fetal complications and satisfaction following ECV.

Main Methods:

• A prospective observational study was conducted involving 41 pregnant women with malpresentation at term.
• An established external cephalic version protocol was implemented.
• Data collected included success rates, complications, maternal and fetal outcomes, and factors influencing ECV success.

Main Results:

• External cephalic version was successful in 63% of the 38 women with available data, with 75% of successful ECVs resulting in vaginal delivery.
• Multiparity (OR=34.0) and a high amniotic fluid index (AFI=4.9) were associated with successful ECV.
• Engagement of the presenting part (OR=0.0001) and the need for backward somersault technique (OR=0.02) were associated with poor success rates. Emergency cesarean section rate for fetal distress was 8%, with no adverse perinatal or maternal outcomes. Maternal satisfaction was high (74%).

Conclusions:

• External cephalic version demonstrates acceptable success rates for managing term malpresentations.
• Key predictors of ECV success include multiparity and amniotic fluid index, while engagement of the presenting part and the backward somersault technique indicate lower success likelihood.
• ECV is a relatively safe and simple procedure associated with high maternal satisfaction, supporting its routine offering in obstetric units.