External cephalic version at term: a cohort study of 18 years' experience

Area of Science:

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

Background:

• Breech presentation at term complicates delivery, often leading to caesarean section.
• External cephalic version (ECV) is a procedure to manually turn the fetus to a cephalic presentation.
• Assessing the outcomes and safety of ECV is crucial for clinical decision-making.

Purpose of the Study:

• To analyze the outcomes of external cephalic version (ECV) referrals.
• To determine the success rates, predictors of success, and perinatal outcomes associated with ECV.
• To evaluate the safety and effectiveness of ECV in term breech presentations.

Main Methods:

• Retrospective cohort study utilizing prospectively collected data from a major UK university hospital.
• Analysis included details of referrals, ECV attempts, and perinatal outcomes for women with non-cephalic presentation at term.
• Multivariate binary logistic regression was used to identify predictors of ECV success, reversion, and spontaneous version.

Main Results:

• Of 2614 women undergoing ECV for breech presentation, success was achieved in 49.0% (40% nulliparous, 64% multiparous).
• Post-ECV, 97.3% of fetuses were cephalic at birth, with 85.7% of these women achieving vaginal delivery.
• Complications were low, with a corrected perinatal mortality of 0.12% and a 2.2% reversion rate after successful ECV.

Conclusions:

• External cephalic version (ECV) is an effective procedure for the majority of term breech presentations.
• ECV offers a viable option to facilitate vaginal birth and reduce caesarean section rates.
• The procedure demonstrates a low complication rate, making it a safe intervention in obstetric practice.