Successful external cephalic version is an independent factor for caesarean section during trial of labor – a matched controlled study

Abstract

IntroductionTo assess the mode of delivery and Caesarean Section (CS) rate after successful External Cephalic Version (ECV). Material and methodsA matched case-control study. Data were gathered from a tertiary care university hospital register from 1996–2015. All pregnant women who delivered after successful External Cephalic Version (ECV). Among 643 women who attempted ECV, we identified 198 with successful ECVs and compared them with the next two women who presented for labor management with spontaneous cephalic presentation, matching for delivery date, maternal age, parity, body mass index, and delivery history using univariate and stepwise logistic regression. The main outcome measure was the risk of caesarean. ResultsThe caesarean section rate was higher after successful ECV (respectively 20.7% versus 7.07%, P<0.05). Caesarean section for abnormal fetal head position (forehead, bregma, face) was higher after successful ECV (28.6% versus 0%). After adjustment for matching and confounding variables (variation of the caesarean section rate over the study period, gestational maternal complications, antepartum fetal complications, term of delivery, induction of labor, oxytocin use for dystocia, neonatal cephalic perimeter), a successful ECV increased the risk of caesarean section (adjusted OR 3.17, 95% CI 1.86–5.46). By stratifying on week, a trend for increased risk for caesarean section was observed at the week after ECV and at post term (28.6% before 37+6, 14.8% at 38+0–38+6, 13.8% at 39+0–39+6, 14.2% at 40+0–40+6 and 33.3% beyond 41+0 weeks’ gestation, P=0.06). ConclusionsWomen who have a successful ECV are at increased risk of caesarean section compared with women who experience spontaneous cephalic presentation.