368: Neonatal morbidity and mortality in women with successful external cephalic version and naturally cephalic presentation

Abstract

External cephalic version (ECV) is an option for women with fetal malpresentation desiring to have a trial of vaginal birth. For those with successful version to cephalic presentation, the associated risks for adverse delivery outcomes compared to naturally cephalic presenting women are unclear. The purpose of our study was to compare maternal and neonatal outcomes between women with successful ECVs and women with naturally cephalic presentations. We conducted a retrospective, population-based cohort study on singleton, term pregnancies using vital statistics data from the United States’ National Center for Disease Control and Prevention (CDC) during the years 2015-2016. Multivariate logistic regression was used to compare the maternal and fetal outcomes of women who underwent successful ECVs with women who had naturally cephalic presentations. During the study period, 9,847 successful ECVs were performed and 6, 330,128 women had cephalic presentations. Women who had successful ECVs were more frequently older in age and multiparous. After adjustment for baseline maternal characteristics, women who underwent a successful ECV were more likely to deliver by cesarean section (OR 1.06, 95% CI 1.01-1.13), to have an instrumental vaginal birth (forceps 2.14, 1.78-2.58; vacuum 1.73, 1.57-1.90), to be induced (2.10, 1.59-1.73), to require a transfusion (2.10, 1.57-2.79), to have an unplanned hysterectomy (3.72,1.93-7.16), and to be admitted to the ICU (2.22, 1.40-3.53). Perinatal death was more common among neonates of women who underwent a successful ECV (1.60, 1.13-2.26), as was the need for assisted ventilation (1.35, 1.20-1.52), the occurrence of seizures (2.72, 1.36-5.45), and admissions to the NICU (1.19, 1.08-1.30). Relative to subjects with a naturally cephalic presentation, women who underwent a successful ECV were at greater risk for maternal and neonatal morbidity and neonatal mortality. These patients should be more closely monitored during the postpartum period.