[Cord accident after external cephalic version: Reality or mostly myth?]

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Fetal Presentation Management

Background:

• External cephalic version (ECV) is a procedure to turn breech presentations to cephalic.
• Cord accidents, such as nuchal cords and prolapse, are potential complications during labor and delivery.
• Understanding the association between ECV outcomes and cord accidents is crucial for optimizing obstetric care.

Purpose of the Study:

• To investigate the occurrence of cord accidents following external cephalic version (ECV).
• To compare cord accident rates based on the success or failure of ECV.
• To evaluate cord accident risks in relation to different delivery modes after ECV attempts.

Main Methods:

• Retrospective study (1998-2015) involving 776 women with breech presentations.
• Four groups were analyzed: successful ECV with trial of labor, failed ECV with subsequent delivery, spontaneous cephalic presentation, and breech presentation without ECV.
• Cord accidents were diagnosed at delivery, comparing rates across groups and delivery interventions.

Main Results:

• The overall prevalence of cord accidents did not significantly differ between women who underwent ECV attempts and those who did not.
• Success or failure of ECV was not associated with a statistically significant difference in cord accident rates.
• Trial of labor after failed ECV did not increase the risk of cord accidents compared to elective cesarean; cord prolapse was rare and observed only during trial of labor.

Conclusions:

• External cephalic version (ECV) outcomes (success or failure) are not linked to an increased risk of cord accidents.
• The management of breech presentation, whether through ECV or other means, should consider these findings to ensure maternal and fetal safety.
• Further research could explore specific types of cord accidents and their nuanced relationship with ECV and labor management.