399 Effectiveness and safety of external cephalic version as a method of reducing cesarean sections rates

Abstract

Introduction: Breech position is a common indication for caesarean section. Elective caesarean section is the mode of choice in this group of patients. RCOG recommends proposing an external cephalic version (ECV) to each patient with a pelvic presentation in a full-term pregnancy in whom no absolute contraindications for external cephalic version and vaginal delivery have been demonstrated. The procedure of external cephalic version is a minimally invasive method, safe for mother and fetus, and yet it is used only a in few centers in Poland. Lack of popularity likely results from the low awareness of patients and limitations in availability of this procedure. Aim of the study: To assess effectiveness and safety of external cephalic version in reducing cesarean sections rates. Methods: This was a retrospective analysis of electronic medical records of patients that requested and were qualified for an external cephalic version. All patients signed an informed consent to undergo the procedure. Results: In 2017-2020, 70 patients were qualified for an external cephalic version. 6 of them had caesarean section before. The success rate was 49%, which is the world average (50%) in terms of the effectiveness of this method. Success rate in the studied group after one caesarean section was 66,7 %. After successful external cephalic version, 26 patients (84%) delivered vaginally, including 3 patients (50%) after cesarean section. 4 patients had an emergency caesarean section (16%). Conclusions: Although ECV is effective in only 50% of cases, we observed a high percentage (84%) of vaginal deliveries after successful ECV. Therefore, we can demonstrate a 37% decrease in elective cesarean section rate among patients with pelvic presentation in the study group. Popularization of ECV among obstetricians and patients seems to be the optimal method of reducing elective cesarean sections rate for breech presentation.