Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• External cephalic version (ECV) is a procedure to turn a breech fetus to a cephalic position before labor.
• Women with a previous cesarean section (CS) are often excluded from ECV due to concerns about uterine rupture.

Purpose of the Study:

• To evaluate the safety and efficacy of ECV in women with a history of cesarean section.
• To compare ECV outcomes in women with previous CS to those in multiparous women without a prior CS.

Main Methods:

• Prospective comparative cohort study conducted at Cruces University Hospital, Spain.
• Compared 70 ECV procedures in women with previous CS to 387 ECV procedures in multiparous women.
• Assessed success rate, ECV complications, and cesarean section rates.

Main Results:

• ECV success rate was 67.1% in women with previous CS, comparable to 66.1% in multiparous women (P=0.87).
• No ECV-related complications, including uterine rupture, occurred in the previous CS cohort.
• Vaginal delivery rate was lower in the previous CS cohort (52.8%) compared to the multiparous cohort (74.9%, P<0.01).

Conclusions:

• ECV is a safe procedure for women with a previous cesarean section, with a success rate similar to multiparous women.
• A uterine scar from a previous CS should not be a contraindication for ECV.
• ECV should be offered to women with a previous CS and breech presentation at term.