Maternal and perinatal outcomes in external cephalic version: prognostic factors for the success of the technique

Abstract

Background We aimed to analyze the success rate of external cephalic version (ECV) for breech presentations performed in our center between March 2011 and March 2016. We evaluated factors related to a successful ECV, delivery mode, complications and newborn status after ECV. Methods Analysis of assembled data of 327 consecutive ECVs in the third trimester was done. Results The total success rate was 56.6%. After a successful ECV, 85.9% of the fetuses were delivered vaginally. Logistic regression analysis of background factors leading to a successful ECV showed that tocolysis with ritodrine and anterior placenta were each significantly correlated with the rate of successful version. No severe complications were registered during the ECVs, and all babies had normal Apgar scores at delivery. Conclusion These findings suggest that attempting an ECV in breech presentations, once or even twice, seems to be an appropriate management given that a successful ECV decreases the rate of cesarean section in this group of patients and by doing so, it might also decrease the risk of cesarean sections in future pregnancies.

External cephalic version at 38 weeks’ gestation at a specialized German single center

“…However, the routine use of ECV resulted in an increase in vaginal delivery. Compared to the international literature, we observed a higher rate of vaginal delivery after NECV (15.5% described by Trobo et al vs. 66.8% in our population) [ 27 ]. Our total rate of vaginal delivery exceeds the German average of 6.75% vaginal delivery from breech presentation by far [ 5 ].…”

“…Nulliparity has been associated with a lower ECV success rate [ 31 ]. The proportion of nulliparous women was lower in our population than in most studies, with approximately 55% nulliparity [ 27 , 32 , 33 ]. This could partially explain the lower success rates at our center.…”

“…The impact of beta-stimulant tocolytics, calcium channel blockers and oxytocin antagonists on the success rate of ECV has already been studied. All drugs have been shown to be safe with only few side effects, but beta-stimulants significantly improved the success rate compared to other tocolytics [ 27 , 34 – 36 ]. In our clinic, fenoterol is a standard tocolytic drug for ECV.…”

“…Factors such as multiparity, posterior placental location, and a high AFI score have been previously described to increase the success rate of ECV in most studies. In contrast, nulliparity, anterior placental location, and oligohydramnion were described to reduce the chances of success [ 20 , 27 , 31 – 33 , 38 , 39 ]. Within our population we were able to confirm the negative impact of an anterior placental location, as well as the positive impact of a high AFI score.…”