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Related Experiment Video

Updated: Oct 25, 2025

External Cephalic Version: Is it an Effective and Safe Procedure?
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A Multivariable Predictive Model for Success of External Cephalic Version.

Carly M Dahl1, Yue Zhang, Janice X Ong

  • 1Department of Obstetrics and Gynecology, Division of Biostatistics, and the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, and the Feinberg School of Medicine, Northwestern University, Chicago Illinois; and the Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven Connecticut.

Obstetrics and Gynecology
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Summary

A new prediction model uses objective patient characteristics like BMI and placental location to estimate external cephalic version (ECV) success probability. This tool aids in counseling and decision-making for pregnant individuals undergoing ECV.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Clinical Prediction Modeling

Background:

  • External cephalic version (ECV) is a procedure to manually turn a fetus from a breech to a cephalic presentation.
  • Predicting ECV success is crucial for informed decision-making and patient counseling.
  • Objective patient characteristics can potentially improve prediction accuracy.

Purpose of the Study:

  • To develop and validate a prediction model for external cephalic version (ECV) success.
  • To identify objective patient characteristics associated with ECV success.
  • To provide a tool for estimating ECV success probability.

Main Methods:

  • Retrospective study of 1,138 pregnant individuals undergoing ECV.
  • Analysis of maternal age, BMI, parity, fetal sex, gestational age, estimated fetal weight, malpresentation, placental location, and amniotic fluid volume.
  • Development of a multivariable logistic regression model using backward elimination and bootstrapping, validated with a calibration curve and AUC.

Main Results:

  • Overall ECV success rate was 40.6%.
  • Significant factors for ECV success included maternal age, parity, placental location, estimated fetal weight, and type of fetal malpresentation.
  • A final model incorporating BMI, parity, placental location, and type of fetal malpresentation achieved an AUC of 0.667 and demonstrated good calibration.

Conclusions:

  • An internally validated prediction model for ECV success was developed.
  • The model utilizes easily obtainable, objective patient factors.
  • This model can assist in clinical decision-making and patient counseling regarding ECV.