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Updated: Oct 15, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Feasibility and Outcomes of External Cephalic Version among Small-for-Gestational-Age Births
Satjeet K Deol Chauhan1, Emily Schlussel Markovic2, Rodney A McLaren2
1BronxCare Health System, Department of Obstetrics and Gynecology, New York, United States, New York.
Objective:
The American College of Obstetricians and Gynecologists (ACOG) recommends that external cephalic version (ECV) be offered to patients with malpresentation. The objective of our study was to evaluate the efficacy and perinatal outcomes among births with small-for-gestational-age (SGA) infants after an ECV.
Study Design:
This was a population-based, cross-sectional study using National Vital Statistics Systems data of singleton, non-anomalous neonates born after 36 weeks of gestation, with a birth weight of < 2,500 g between 2021 and 2023. Births with a maternal history of previous cesarean delivery were excluded. Births were divided into those who had an ECV attempt and those with a breech fetus at cesarean delivery without a trial of labor. Adverse maternal outcomes (blood transfusion, intensive care unit [ICU] admission, unplanned hysterectomy) and neonatal outcomes (assisted ventilation use, neonatal ICU [NICU] admission, seizures, surfactant use, death) were compared between groups using logistic regression.
Results:
A total of 8,021 births were included. Of the 8,021 births, 812 (10.1%) had an ECV attempt and 7,209 (89.9%) had a primary breech cesarean delivery. There were significant differences in baseline characteristics between groups. Among the 812 births who had an ECV attempt, 338 (41.6%) had a successful ECV, of which 233 (68.9%) subsequently delivered vaginally. After adjusting for differences, births that had an ECV attempt had lower odds of neonatal-assisted ventilation use (adjusted odds ratio [aOR] 0.65, 95% confidence interval [0.46-0.92]) and NICU admission (aOR 0.48, 95% confidence interval [0.40-0.58]) than those who had a primary breech cesarean delivery. There were higher odds of maternal transfusion in the breech cesarean delivery cohort as compared with those who had an ECV attempt (odds ratio 2.81, 95% confidence interval [1.42-5.56]).
Conclusion:
Although ECV was successful in 41.6% of births with SGA infants, there were lower rates of assisted ventilation use and NICU admission among those who underwent an ECV attempt.
Key Points:
· ECV was successful in 41.6% of SGA births.. · After successful ECV, 68.9% delivered vaginally.. · ECV attempts had lower odds of NICU admission..