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

To evaluate the effectiveness and safety of external cephalic version (ECV) performed with tocolysis and sedation or spinal anesthesia, and to identify predictors of ECV success, complications, and delivery outcomes after successful ECV.

This 10-year cohort study included 990 pregnant women with term non-cephalic presentation at a tertiary hospital in Spain. Data were collected retrospectively (2014-2020) and prospectively (2020-2024). All ECVs followed a standardized protocol using ritodrine plus either propofol sedation or spinal anesthesia. Multivariable logistic regression identified predictors of ECV success and complications, and delivery outcomes were recorded.

ECV was successful in 691/990 (69.8%). Factors associated with higher success included a deepest amniotic fluid pocket >30 mm (OR = 1.80; 95%CI 1.04-3.11) and transverse lie (OR = 3.60; 95%CI 1.74-7.45). Lower success was observed in nulliparous women (OR = 0.55; 95%CI 0.40-0.76) and those with BMI between 30 and 35, and >35 kg/m² (OR = 0.53 and 0.49 respectively). Complications occurred in 101/990 (10.2%), including 67/990 (6.7%) emergent cesarean sections. After successful ECV, 556/691 (80.5%) delivered vaginally.

In this high-volume tertiary center, ECV performed with systematic tocolysis and sedation or spinal anesthesia achieved high success and low complication rates, supporting the safety and feasibility of this optimized protocol.