Feasibility and Outcomes of External Cephalic Version among Small for Gestational Age (SGA) births

OBJECTIVE- The American College of Obstetricians and Gynecologists 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 Vitality Statistics data of singleton, non-anomalous, neonates born after 36 weeks of gestation, with birthweight of < 2500g between 2021 and 2023. Births with a maternal history of previous cesarean delivery (CD) were excluded. Births were divided into those who had an ECV attempt and those with a breech fetus at CD 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 CD. 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 (aOR 0.65, 95% CI [0.46-0.92]) and NICU admission (aOR 0.48, 95% CI [0.40-0.58]) than those who had a primary breech CD. There were higher odds of maternal transfusion in breech CD cohort as compared to those who had an ECV attempt (OR 2.81, 95% CI [1.42- 5.56]). CONCLUSION- Although ECV was successful in 41.6% births with SGA infants, there were lower rates of assisted ventilation use and NICU admission among those who underwent an ECV attempt.