External cephalic version at term using broad criteria: effect on mode of delivery

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Maternal-Fetal Medicine

Background:

• Breech presentation at term is associated with increased risks of cesarean delivery.
• External cephalic version (ECV) is a procedure to turn the fetus from breech to cephalic presentation.
• The safety and efficacy of ECV with tocolytic agents in a broad patient population require further evaluation.

Purpose of the Study:

• To determine if external cephalic version (ECV) with tocolytic agents can safely reduce cesarean sections and vaginal breech deliveries in term patients.
• To assess the effectiveness of ECV in a diverse group of patients with breech presentation at term.

Main Methods:

• Retrospective review of 432 patients undergoing attempted ECV and 330 controls with breech presentation at term.
• ECV was performed using Saling and Muller-Holve's back flip or the classic forward roll, following ritodrine hydrochloride infusion.
• Oxytocin was administered after successful ECV to stabilize fetal head position.

Main Results:

• Successful ECV was achieved in 72% (311/432) of attempted cases, with 86% of these resulting in vaginal delivery.
• Cesarean sections were performed in 76% of patients with unsuccessful ECV and 64% of the control group.
• ECV significantly reduced the rate of cesarean sections compared to the control group.

Conclusions:

• External cephalic version (ECV) at term, utilizing tocolytic agents, is a safe and effective method for managing breech presentations.
• ECV significantly decreases the incidence of cesarean sections by increasing the rate of vaginal deliveries.
• The procedure is beneficial across a broad spectrum of patients with term breech presentation.