670: Is there an association between attempted external cephalic version and neonatal morbidity?

Abstract

External cephalic version (ECV) can be complicated by fetal bradycardia, abruption, or cord prolapse leading to adverse neonatal outcomes. However the alternative to ECV, expectant management, also carries risks associated with an unscheduled presentation in labor with a non-cephalic fetus. We sought to examine whether, in the setting of non-cephalic presentation, women who undergo an ECV attempt have greater neonatal morbidity than those who do not and are expectantly managed. A retrospective cohort study of women with non-anomalous singleton gestations in non-cephalic presentation delivering at a tertiary care institution from 2006-2016. Women attempting ECV at ≥37 weeks were compared to those who did not undergo an ECV attempt with a noncephalic neonate and delivered at ≥37 weeks. The primary outcome was a composite neonatal morbidity including stillbirth, neonatal death within 72 hours, Apgar score <5 at 5 minutes, cord artery pH <7.0 or base deficit ≥12 mmol/L, or neonatal brain cooling. Secondary outcomes were neonatal intensive care unit (NICU) admission and neonatal anemia (Hgb <13.5 g/dL). Bivariable analyses and multivariable logistic regression were performed. Of a total of 4117 women, 1262 (30.7%) attempted ECV; 508 (40.3%) of these attempts successfully converted the fetus to cephalic presentation. In bivariable analyses, women who attempted ECV were more likely to be non-Hispanic white and multiparous, and had a lower mean body mass index at delivery. The composite neonatal morbidity outcome did not differ significantly between the groups. The frequencies of NICU admission and neonatal anemia were also similar (Table). After adjusting for potential confounders, ECV attempt was still not significantly associated with composite neonatal morbidity (aOR 1.02, 95% CI 0.66-1.35). Using an alpha of 0.05, we had 80% power to detect a minimum relative risk of 1.7 for composite neonatal morbidity associated with ECV attempt. Compared to expectant management, an ECV attempt at ≥37 weeks is not associated with increased neonatal morbidity.