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External cephalic version after previous cesarean section.

B L Flamm1, M W Fried, N M Lonky

  • 1Department of Obstetrics and Gynecology, Kaiser Permanente Medical Centers, Los Angeles, Riverside, CA 92505.

American Journal of Obstetrics and Gynecology
|August 1, 1991
PubMed
Summary
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External cephalic version is a safe procedure for breech presentation in women with prior cesarean sections. This method successfully converted breech presentations, enabling vaginal birth after cesarean section in many cases.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine

Background:

  • Breech presentation accounts for approximately 100,000 cesarean sections annually in the U.S.
  • External cephalic version (ECV) is a known method to reduce cesarean births for breech presentation.
  • Exclusion of women with prior cesarean sections from ECV studies due to uterine rupture concerns.

Purpose of the Study:

  • To evaluate the safety and efficacy of external cephalic version in women with previous cesarean sections and term breech presentation.
  • To assess the potential for vaginal birth after cesarean section (VBAC) following successful ECV in this patient group.

Main Methods:

  • Prospective study of 56 women with one or more prior cesarean sections and term breech presentation.
  • External cephalic version attempts were performed near term.

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  • Outcomes including version success rates, VBAC rates, and complication incidence were recorded.

    • Main Results:

    • External cephalic version was successful in 82% of the 56 patients.
    • Of those with successful versions, 65% achieved a vaginal birth after cesarean section.
    • No serious maternal or fetal complications were observed during or after the ECV attempts.

    Conclusions:

    • External cephalic version is a viable and safe option for women with term breech presentation and a history of low transverse cesarean section.
    • ECV can increase the likelihood of vaginal birth after cesarean section, reducing the need for repeat cesarean delivery.
    • The exclusion of women with prior cesarean sections from ECV protocols may be unwarranted.