Safety and Efficacy of External Cephalic Version for Women With a Previous Cesarean Delivery

Abstract

There is increasing use of external cephalic version (ECV) in women with previous cesarean delivery (CD) and a breech-presenting fetus who want a vaginal delivery. However, clear evidence to support its use is lacking and some clinicians believe that prior CD is a relative contraindication for a trial of ECV. This retrospective study investigated the effectiveness and safety of ECV in a study group of 42 singleton women with 1 previous cesarean delivery (CD) and a breech-presenting fetus at term. The study was conducted at a single medical center between 1997 and 2005. The comparison group was multiparous women at the same institution who had an ECV without a previous CD during the same time period. A Medline search was performed for the years 1966–2008 to provide data from other published studies evaluating attempted ECV in women with prior CD. The success rate of ECV was 74.0% (31/42) in the study group and 72.3% (251/347) in the comparison group. Eighty-four percent of the study group women with successful ECV were delivered vaginally and 91% with failed ECV delivered by CD. Among the 162 publications from the Medline search, the 4 meeting inclusion criteria included a total of 124 patients and had a mean ECV success rate of 76.6%. Adding data from this study to that in the 4 Medline reports showed an average success rate of 76.5% for ECV performed in 166 women with 1 previous CD. There were no serious maternal or fetal complications or outcomes with a rate of emergency CD of only 0.6% (1/166 cases). Accumulating evidence for the efficacy and safety of ECV among women with a breech presenting-fetus at term and previous CD leads the investigators to conclude that such women who desire a vaginal delivery should be offered a trial of ECV.