Obstetrical and neonatal outcomes following unsuccessful external cephalic version: a stratified analysis amongst failures, successes, and controls

Abstract

Objective: Though on average one out of every two external cephalic versions (ECV) fails to rotate the breech fetus, little is known about the outcomes of pregnancies in which ECV is unsuccessful. The objective of the present study is to compare obstetrical and neonatal outcomes following failure of ECV, relative to cases of breech controls without an attempt at ECV.Study design: We conducted a retrospective, population-based, cohort study using the CDC's Birth Data files from the US for the year 2006. We stratified the cohort according to fetal presentation and ECV status: success, failure, and no ECV (controls). The effect of failure of ECV on the risk of several neonatal and obstetrical outcomes was estimated using logistic regression analysis, adjusting for relevant confounders.Results: We analyzed a total of 4 273 225 births, out of which 183 323 (4.3%) met inclusion criteria. Relative to breech controls, failed ECV occurred more frequently amongst Caucasian, college-educated, married women bearing a female fetus. Compared to no ECV, failure of ECV was associated with increased odds of PROM (aOR, 1.75; 95% CI, 1.60–1.90), elective cesarean delivery (aOR, 1.53; 95% CI, 1.36–1.72), cesarean delivery in labor (aOR, 1.38; 95% CI, 1.21–1.57), abnormal fetal heart tracing (aOR, 1.78; 95% CI, 1.50–2.11), assisted ventilation at birth (aOR, 1.50; 95% CI, 1.27–1.78), 5-min APGAR scores <7 (aOR, 1.35; 95% CI, 1.20–1.51), and NICU admission (aOR, 1.48; 95% CI, 1.20–1.82). The delayed spontaneous fetal restitution rate was 13%. When stratifying controls with regards to trial of labor status, the increased risk of failed ECV persisted for cesarean delivery, NICU admission, assisted ventilation and abnormal fetal tracing, independently of whether a trial of labor took place.Conclusion: Relative to breech controls without attempt at ECV, failure of ECV to restitute cephalic presentation appears to be associated with an increased risk of adverse perinatal and obstetrical outcomes.