Vaginal Delivery After External Cephalic Version in Patients With a Previous Cesarean Delivery

Abstract

OBJECTIVE: To estimate the rate of vaginal delivery after successful external cephalic version for breech presentation in women with compared with without a previous cesarean birth. DATA SOURCES: We searched MEDLINE, Scopus, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the mode of delivery after successful external cephalic version in women with and without a previous cesarean birth. METHODS OF STUDY SELECTION: Two reviewers independently identified studies, extracted data, and evaluated study quality. The rate of vaginal delivery after successful external cephalic version in women with and without a previous cesarean birth was compared, and odds ratios (ORs) with 95% CIs were estimated. TABULATION, INTEGRATION, AND RESULTS: Six cohort studies and two case–control studies, reporting on 14,515 women were identified. The median point prevalence of a successful external cephalic version was 74% (interquartile range 63–81%) in women with a previous cesarean birth compared with 69% (interquartile range 64–83%) in women without a previous cesarean birth. The overall success rate of external cephalic version in women with a previous cesarean birth was similar compared with women without a previous cesarean birth (pooled OR 0.84, 95% CI 0.61–1.15). The median point prevalence of a vaginal delivery was 75% (interquartile range 61–84%) in women with a previous cesarean birth compared with 92% (interquartile range 85–95%) in women without a previous cesarean birth after a successful external cephalic version. The overall success rate of a vaginal delivery in women with a previous cesarean birth was less compared with women without a previous cesarean birth (pooled OR 0.26, 95% CI 0.14–0.50). A planned subgroup analysis on studies that included only multiparous women in the control group (parity one or greater) noted the overall success rate of external cephalic version in women with a previous cesarean birth 76% (853/1,123) was lower compared with multiparous women without a previous cesarean birth 84% (9,911/11,855) (pooled OR 0.70, 95% CI 0.54–0.89, I2 37%). The overall success rate of a vaginal delivery in women with a previous cesarean birth 83% (666/806) was less compared with women without a previous cesarean birth 97% (9,449/9,746) (pooled OR 0.21, 95% CI 0.12–0.39, I2 73%). CONCLUSION: Women with previous cesarean birth have similar rates of successful external cephalic version when compared with women without a cesarean birth. Although the rate of vaginal delivery is lower, the majority of patients have a successful vaginal birth after cesarean. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020160145.

External Cephalic Version—A Chance for Vaginal Delivery at Breech Presentation

“…According to the literature, ECV is considered safe in women with a history of CS and some studies showed that the success rate of ECV is comparable to that of women with no previous CS [29][30][31][32]. Although rare, we registered four cases with a history of CS.…”

What is an appropriate caesarean delivery rate for China: a multicentre survey

“…In a previous meta‐analysis, external cephalic version had a success rate of 43% in avoiding CD 32 . Even in women with fetal breech presentation and a scarred uterus, external cephalic version could bring about a vaginal delivery rate of 83% in a recent meta‐analysis 33 . Numerous studies further suggest that compared with vaginal delivery, CD cannot significantly decrease adverse maternal and perinatal outcomes for singleton pregnancy with non‐cephalic presentation or multiple pregnancies 34 .…”

“…32 Even in women with fetal breech presentation and a scarred uterus, external cephalic version could bring about a vaginal delivery rate of 83% in a recent meta-analysis. 33 Numerous studies further suggest that compared with vaginal delivery, CD cannot significantly decrease adverse maternal and perinatal outcomes for singleton pregnancy with non-cephalic presentation or multiple pregnancies. 34 Therefore, vaginal delivery should be encouraged first, particularly for a normal term twin gestation with a cephalic presentation of the first twin.…”

Successful Vaginal Delivery after External Cephalic Version in a Woman with a Large Partial Uterine Septum

“…Varying rates of ECV success have been reported in the general obstetric population. A meta-analysis of 85 studies reported a pooled success rate of 58% [11][12][13][14]. Although ECVs play a significant role in reducing cesarean delivery rates, there is limited data on ECV success rates in women with uterine abnormalities.…”