External cephalic version following prior cesarean delivery: A comparative cohort analysis

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Procedures

Background:

• External cephalic version (ECV) is a procedure to turn a fetus from a breech to a cephalic presentation.
• Women with a history of cesarean delivery represent a growing population for whom ECV is considered.
• Assessing ECV success and safety in this specific group is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the success rate of external cephalic version (ECV) in pregnant women with a prior cesarean section.
• To determine the complication rate associated with ECV in women with a history of cesarean delivery.
• To compare ECV outcomes between women with and without previous cesarean sections.

Main Methods:

• Retrospective cohort study including 911 women offered ECV between 2014 and 2023.
• Data collected on obstetric history, ECV success, complications, and delivery mode.
• Statistical analyses, including univariate and multivariate, were performed to compare outcomes.

Main Results:

• ECV was performed in 42 women with a previous cesarean section, achieving a success rate of 78.6%.
• The complication rate was low at 9.5%, including non-reassuring fetal heart rate (7.1%) and vaginal bleeding (2.4%).
• Vaginal delivery after successful ECV was achieved in 80.8% of women with a prior cesarean.

Conclusions:

• External cephalic version is a safe and effective procedure for women with a previous cesarean section.
• ECV success rates in women with prior cesarean delivery are comparable to those without.
• These findings support offering ECV to appropriate candidates with a history of cesarean delivery.