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Related Experiment Video

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External Cephalic Version: Is it an Effective and Safe Procedure?
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Association Between Attempted External Cephalic Version and Perinatal Morbidity and Mortality.

Moeun Son1, Archana Roy, William A Grobman

  • 1Division of Maternal-Fetal Medicine and the Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

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Summary

Attempting external cephalic version (ECV) for fetal malpresentation at term does not increase perinatal morbidity or mortality compared to expectant management. This study found no significant differences in adverse outcomes for mothers undergoing ECV.

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Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Medicine
  • Maternal-Fetal Medicine

Background:

  • Fetal malpresentation at term, such as breech presentation, is associated with increased perinatal risks.
  • External cephalic version (ECV) is a procedure to externally turn the fetus to a cephalic (head-down) position.
  • The safety and efficacy of ECV in reducing adverse perinatal outcomes require ongoing investigation.

Purpose of the Study:

  • To compare perinatal morbidity and mortality between women attempting external cephalic version (ECV) and those managed expectantly for fetal malpresentation at term.
  • To assess the association between ECV attempts and key perinatal outcomes.

Main Methods:

  • Retrospective cohort study of women with singleton gestations in nonvertex presentation at term (≥37 weeks).
  • Comparison of women undergoing ECV attempts versus those expectantly managed.
  • Primary outcome: composite of perinatal morbidity and mortality (stillbirth, neonatal death, low Apgar score, low umbilical artery pH, therapeutic hypothermia).
  • Secondary outcomes: NICU admission and neonatal anemia.

Main Results:

  • A total of 4,117 women were included; 30.7% attempted ECV.
  • No significant difference in the composite perinatal morbidity and mortality outcome between ECV attempt and expectant management groups (2.9% vs 2.5%, P=.46).
  • Secondary outcomes, including NICU admission and neonatal anemia, were also similar between groups.

Conclusions:

  • External cephalic version (ECV) attempts at term for fetal malpresentation are not associated with increased perinatal morbidity or mortality.
  • Expectant management for nonvertex fetuses at term yields comparable perinatal outcomes to attempted ECV.