Predictive factors for successful external cephalic version with regional anesthesia

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatology

Background:

• External cephalic version (ECV) is a procedure to manually turn a fetus from a breech to a cephalic presentation before labor.
• Regional anesthesia and tocolytics like ritodrine hydrochloride are commonly used to facilitate ECV.
• Identifying predictors of ECV success is crucial for optimizing patient selection and procedural outcomes.

Purpose of the Study:

• To investigate maternal demographic and ultrasound-derived factors that predict the success of external cephalic version (ECV) performed under regional anesthesia.
• To identify specific patient characteristics that can guide the selection process for ECV.

Main Methods:

• Retrospective analysis of 608 women undergoing ECV between 2010 and 2022, with procedures performed under regional anesthesia and intravenous ritodrine hydrochloride.
• Logistic regression analysis was employed to determine the association between maternal factors, ultrasound findings (including maximum vertical pocket - MVP), and ECV success.
• ECV success was defined as successful rotation from a non-cephalic to a cephalic presentation.

Main Results:

• The overall ECV success rate was 76.3%.
• Multiparity (adjusted OR: 2.06) was associated with significantly higher success rates compared to primiparity.
• A maximum vertical pocket (MVP) of <4 cm was linked to lower success rates (OR: 0.56), while a non-anterior placental location showed higher success rates (OR: 1.46) compared to an anterior placenta.

Conclusions:

• Multiparity, a maximum vertical pocket (MVP) greater than 4 cm, and a non-anterior placental location are significant predictors of successful external cephalic version (ECV).
• These identified factors can assist clinicians in selecting appropriate candidates for ECV, potentially improving procedural success rates.