External cephalic version outcomes with tocolysis and sedation: A 10-year retrospective cohort study

Area of Science:

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

Background:

• External cephalic version (ECV) is a procedure to externally manipulate a fetus from a non-cephalic to a cephalic presentation before labor.
• Optimizing ECV protocols is crucial for improving success rates and reducing the need for cesarean deliveries.
• Tocolysis and anesthesia are commonly used to facilitate ECV, but their combined impact requires further evaluation.

Purpose of the Study:

• To assess the effectiveness and safety of external cephalic version (ECV) using a protocol combining tocolysis with either sedation or spinal anesthesia.
• To identify predictors associated with ECV success, procedural complications, and subsequent delivery outcomes.
• To evaluate the feasibility of this optimized ECV protocol in a high-volume tertiary care setting.

Main Methods:

• A 10-year cohort study (n=990) of pregnant women with term non-cephalic presentations.
• Standardized ECV protocol involving ritodrine tocolysis plus either propofol sedation or spinal anesthesia.
• Multivariable logistic regression analysis to determine predictors of success and complications; delivery outcomes were recorded.

Main Results:

• ECV success rate was 69.8% (691/990).
• Predictors of success included deeper amniotic fluid pockets and transverse lie; nulliparity and higher BMI were associated with lower success.
• Complication rate was 10.2% (101/990), with 6.7% (67/990) requiring emergent cesarean section. Vaginal delivery occurred in 80.5% (556/691) following successful ECV.

Conclusions:

• ECV performed with systematic tocolysis and sedation or spinal anesthesia demonstrates high success and low complication rates.
• The optimized protocol is safe and feasible, supporting its use in high-volume tertiary centers.
• This approach can potentially increase vaginal birth rates for term breech presentations.