External Cephalic Version Attempt Research Articles

Prediction Models for Successful External Cephalic Version: An Updated Systematic Review.

To review the decision aids currently available or being developed to predict a patient's odds that their external cephalic version (ECV) will be successful. We searched PubMed/MEDLINE, Cochrane Central, and ClinicalTrials.gov from 2015 to 2022. Articles from a pre-2015 systematic review were also included. We selected English-language articles describing or evaluating models (prediction rules) designed to predict an outcome of ECV for an individual patient. Acceptable model outcomes included cephalic presentation after the ECV attempt and whether the ECV ultimately resulted in a vaginal delivery. Two authors independently performed article selection following PRISMA 2020 guidelines. Since 2015, 380 unique records underwent title and abstract screening, and 49 reports underwent full-text review. Ultimately, 17 new articles and 8 from the prior review were included. Of the 25 articles, 22 proposed one to two models each for a total of 25 models, while the remaining 3 articles validated prior models without proposing new ones. Of the 17 new articles, 10 were low, 6 moderate, and 1 high risk of bias. Almost all articles were from Europe (11/25) or Asia (10/25); only one study in the last 20 years was from the United States. The models found had diverse presentations including score charts, decision trees (flowcharts), and equations. The majority (13/25) had no form of validation and only 5/25 reached external validation. Only the Newman-Peacock model (United States, 1993) was repeatedly externally validated (Pakistan, 2012 and Portugal, 2018). Most models (14/25) were published in the last 5 years. In general, newer models were designed more robustly, used larger sample sizes, and were more mathematically rigorous. Thus, although they await further validation, there is great potential for these models to be more predictive than the Newman-Peacock model. Only the Newman-Peacock model is ready for regular clinical use. Many newer models are promising but require further validation. · 25 ECV prediction models have been published; 14 were in the last 5 years.. · The Newman-Peacock model is currently the only one with sufficient validation for clinical use.. · Many newer models appear to perform better but await further validation..

Use of external cephalic version for breech presentation at term: A national survey of Norwegian birth units

IntroductionInternational guidelines recommend that external cephalic version (ECV) be offered to all women with single fetuses in breech presentation at term. In Norway, ECV is not offered routinely; the national clinical guidelines advice that birth units capable of offering ECV for breech pregnancies make their own practice decisions. This study was performed to determine the extent to which Norwegian birth units offer ECV to pregnant women with fetuses in breech presentations at term, and to identify factors that might influence the use of ECV. Material and methodsA survey of all 39 obstetric birth units providing ECV in Norway was conducted using a self‐reporting questionnaire about ECV availability, attitudes, clinical procedures, perceived competence, and outcome expectations. ResultsChief obstetricians from all birth units responded. Twenty-six (67%) respondents reported that their units offered ECV for breech presentation at term to a large degree. Thirty-one (80%) respondents reported a large degree of competence in performing ECV. Thirty-three (85%) units followed local ECV procedures. Nineteen (49%) units provided standardized information about the procedure to pregnant women. The respondents had different views about who should be offered ECV, and varying knowledge about ECV outcomes. ConclusionsThe majority of Norwegian birth units offer ECV to pregnant women with fetuses in breech position to a large extent. However, the survey results reveal challenges related to ECV information provision to pregnant women, determination of women’s eligibility for ECV attempts, and familiarity and agreement with the knowledge base regarding ECV.

Characteristics That Influence the Success of External Cephalic Version in Nulliparous Women [A198

INTRODUCTION: Studies identified that nulliparous women (NW) are at increased risk for failed external cephalic version (ECV). This study examined maternal characteristics and maternal/neonatal outcomes of NW with failed and successful ECVs. METHODS: Using the NBER Natality Database (2016–2018) ECV attempts in NW were identified. ECV success and cesarean delivery (CD) rates were calculated. Maternal demographics, comorbidities, and neonatal outcomes were compared between cohorts using bivariate analysis. Statistically significant (P<.001) differences were reported. RESULTS: The ECV success rate in 13,015 NW was 40.0%. Black NW had the highest success rate (54.5%), followed by Hispanic (49.1%), Asian/Pacific Islander (45.0%), White (37.8%), and American Indian/Alaskan Native (27.2%) NW. Self-pay NW had the highest ECV success rate (58.3%), followed by Medicaid (45.2%), and private insurance (26.8%). Successful ECV saw decreased neonatal ventilation (5.4% versus 6.8%) but increased NICU admission (9.9% versus 6.7%). NW with successful ECV had a 29.9% CD rate. Higher CD rates were found in NW with a history of hypertension (54.3% versus 29.4%), gestational diabetes mellitus (56.3% versus 28.9%), and gestational hypertension (38.3% versus 29.2%). There was no association between race or payer status and CD rate after successful ECV. Pertinent negatives for both cohorts include, age, BMI, history of diabetes, birth weight, gestational age at birth, Apgar scores, neonatal seizures, maternal ICU admission, transfusion, and unplanned hysterectomy. CONCLUSION: When counseling NW on ECV, it is important to fully account for several factors that affect the chance of ECV success or CD. The reasons for the impact of the factors found here will require further investigation.

Management of external cephalic version in France: A national practice survey

IntroductionThe breech presentation represents 4,7% of deliveries at term. There is a method of external cephalic version (ECV) performed from 36 weeks of gestation. French guidelines for the clinical practice of ECV were published in 2020. ObjectiveTo evaluate the national practices of ECV in French maternity units, especially on the use of tocolysis, 1 year after publication of the French clinical recommendations guidelines by the French national college of obstetricians and gynecologists (CNGOF). MethodsData self-reported for this national descriptive study were collected from March to May 2021 by an online questionnaire distributed to all French maternities. The 25 items of the questionnaire collected information of maternity units, the general practice of ECV, use or not of tocolysis for ECV attempt and the relevance of a prospective study. ResultsOf the 517 French maternity units, 150 (29%) responded to the online survey. 95,3% systematically performed ECV. A Kleihauer test was routinely performed in 71 units (49.7%). A tocolysis was associated with ECV attempt in 52.4% of cases. The drugs used were intravenous atosiban (30,7%), mainly in levels 2b and 3 maternity units, intravenous salbutamol (24%), other mode of administration of salbutamol (14,7%) and oral nifedipine (22,6%) mainly in levels 1 and 2a maternity units. Adverse effects were described in 20%, mainly with the use of salbutamol (73,3%). Conclusions52.4% of the French maternity units surveyed used tocolysis for the ECV attempt, although it is systematically recommended. The choice of tocolytic drug differed according to the maternity units.

Patient characteristics associated with complications of external cephalic version

Patient characteristics associated with external cephalic version success are well documented; however, the association between patient characteristics and the likelihood of external cephalic version complications is poorly understood. This study aimed to assess the frequency of patient characteristics associated with complications that lead to unanticipated delivery during external cephalic version. This retrospective study included pregnant women aged at least 18 years with singleton gestations who underwent an external cephalic version attempt between 2006 and 2016 at a single quaternary care center. External cephalic version complications were defined as persistent nonreassuring fetal status, placental abruption, labor, spontaneous rupture of membranes, and umbilical cord prolapse. Complications were only considered if they led to unanticipated induction or cesarean delivery within 24 hours of external cephalic version. Patient characteristics including maternal age, height, weight, body mass index, parity, fetal sex, gestational age, estimated fetal weight, the type of fetal malpresentation, and placental location were analyzed for their association with external cephalic version complications using univariable analysis and multivariable logistic regressions. Among the 1138 patients included in this analysis, external cephalic version complications occurred in 6.7% (n=76). These complications (not mutually exclusive) included nonreassuring fetal status (4.8%, n=55), placental abruption (1.6%, n=18), labor (1.0%, n=11), spontaneous rupture of membranes (0.6%, n=7), and cord prolapse (0.1%, n=1). Neonatal outcomes for those with complications included intensive care unit admission (10.5%, n=8), 5-minute Apgar scores <5 (1.3%, n=1), cord arterial pH <7 (6.6%, n=5), head cooling (1.3%, n=1), and anemia (6.6%, n=5). There were no perinatal deaths. In multivariable analysis, higher body mass index (adjusted odds ratio, 0.90 per kg/m2; 95% confidence interval, 0.84-0.97) and estimated fetal weight (adjusted odds ratio, 0.998 per gram; 95% confidence interval 0.998-0.999) were associated with decreased likelihood of experiencing external cephalic version complications, whereas greater gestational age at procedure (adjusted odds ratio, 1.95 per week; 95% confidence interval, 1.4-2.7) and anterior placental location (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.7) were associated with increased likelihood of experiencing external cephalic version complications. In this large series, complications that led to delivery during external cephalic version occurred in 6.7% patients and were associated with body mass index, estimated fetal weight, gestational age, and placental location.

Maternal body mass index and external cephalic version success rate - are they related?

External cephalic version (ECV) is a useful method helping to reduce the incidence of planned caesarean deliveries for fetal malpresentation. There is an effort to look for the best predictors for a successful ECV, the effect of maternal weight is still unclear. The aim of our study is to determine maternal body mass index (BMI) in association with the ECV success rate and the risk of complications. A retrospective observational cohort study in 981 women after the 36th week of gestation with a fetus in a breech presentation who had undergone an ECV attempt. We evaluated the success rate and complications of ECV in association with BMI categories according to the WHO classification of obesity. ECV was successful in 478 cases (48.7%). In the category of overweight patients (BMI > 25; n = 484), ECV was successful in 51% and unsuccessful in 49% (p = 0.28) of cases. In obese patients (BMI > 30; n = 187), ECV was successful in 44.8% and unsuccessful in 55.2% (p = 0.28) of cases. The effect of BMI on the success rate of ECV for the category of overweight and obesity was not proven by statistical analysis. Serious complications occurred in seven cases in similar numbers in all three subgroups according to BMI. BMI in the categories of overweight and obesity is not a factor influencing the success rate and risk of complications of ECV. These results can be helpful when consulting pregnant women the chance of successful ECV.

283 The surprising impact of maternal weight on the success of external cephalic version

Maternal obesity is considered an impediment for a successful external cephalic version (ECV). We aimed to evaluate the impact of maternal pre-pregnancy body mass index (BMI) and weight gain during pregnancy (WG) on the success rate of ECV. Retrospective analysis of the United States (US) Natality Live Birth database from the Centers for Disease Control and Prevention (2016-2018). The data were analyzed for singleton term births following an ECV attempt with a birth weight between 2500 and 5000 grams. Women were divided into several groups based on their BMI and WG. The success rates of ECV were compared among the different BMI and WG categories using the Pearson chi-square test with the Bonferroni adjustment for multiple comparisons. A logistic regression was used to calculate the independent contribution of maternal BMI and WG to the success of ECV, after controlling for maternal race/ethnicity, parity and neonatal birth weight. Results were displayed as odds ratios with 95% confidence intervals, and statistical significance was determined as a p-value below 0.05. Of the 11,150,527 live births in 2016 to 2018, 26,255 women who underwent an ECV attempt met the inclusion criteria. The overall ECV success rate was 52.75% (13,850 women). The success rates of ECV for the different BMI and WG categories ranged from 47.43% to 55.18% (Table 1). Although the overall differences in the success rates were small, a logistic regression model demonstrates that the odds for a successful ECV consistently decline with increasing BMI and with increasing WG (Table 2). We document a significant association between increases in both maternal BMI and WG and lower success rates of ECV. Nevertheless, given the small magnitude of these differences, with the exception of Extreme Obesity, these statistically significant differences are not clinically significant. Clinicians should therefore not rely heavily on maternal weight when considering an ECV attempt.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

51 A Multivariable Predictive Model for Success of External Cephalic Versions

To create a user-friendly prediction model for external cephalic version (ECV) success using patient characteristics in a US-based population. A retrospective case control was performed of women who underwent an ECV attempt between 2006 and 2016 who were at least 18 years of age with a non-anomalous, singleton pregnancy. Variables assessed included maternal age, height, weight, BMI, parity, fetal sex, and obstetric information known at the ECV procedure (gestational age, estimated fetal weight, fetal position, placental location, and amniotic fluid volume). Univariable and multivariable logistic regressions were used to determine the association of patient characteristics with ECV success. Estimated odds ratios and corresponding 95% confidence intervals were calculated for each variable, and a parsimonious model for ECV success was determined using bootstrapping (N=2000) to find the model with the highest discriminatory capacity [as determined by the area under the receiver operating characteristic curve (AUC)]. 1138 patients were included in this analysis. The overall ECV success rate was 40.6%. Factors significantly associated with ECV success were maternal age, BMI, parity, placental location, estimated fetal weight, and fetal position. A model with BMI, parity, placental location, and fetal position (Table) had the highest AUC [0.667 (CI 0.634-0.701)], resulted in good calibration (Figure), and is represented by the following equation: 1/(1+eˆ(-x)) where x=1.1726 - 0.0314 (BMI) - 0.9299 (nulliparity) + 1.0218 (transverse/oblique position at ECV) – 0.5113 (anterior placenta). An interactive version of this equation was created and can be accessed at http://www.ecvcalculator.com/. A user-friendly “ECV Success Calculator” can be created that uses easily obtainable patient factors and can be used as an aid in patient counseling.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Scoring system to predict the success rate of external cephalic versions and determine the timing of the procedure.

We aimed to examine the prenatal clinical characteristics of women with single pregnancies undergoing external cephalic version (ECV) without anesthesia, develop a novel scoring system for predicting the ECV success rate, and demonstrate that this scoring system can be used to individualize the timing of ECV attempts. We enrolled 270 women who underwent ECV without anesthesia at 37-40 weeks of gestation in the Fujian Maternity and Child Health Hospital from 2016 to 2019 and divided them into two ECV outcome groups (success vs. failure). We identified five clinical features (the fetal buttocks' station, the sum of the fundal height and station, the fetal head location, and whether the fetal head or buttocks could be grasped) as independent factors affecting the ECV success rate, and we scored them using a regression coefficient. Women with scores of 0-3 points had ECV success rates, vaginal delivery rates, and delivery gestational ages at 16.67%, 16.67%, and 38.88 weeks, respectively; those with scores of 4-6 points had ECV success rates, vaginal delivery rates, and delivery gestational ages at 65.75%, 58.90%, and 39.62 weeks, respectively; and those with scores of 7-9 points had ECV success rates, vaginal delivery rates, and delivery gestational ages at 93.71%,74.83%, and 40.00 weeks, respectively. The ECV success and vaginal delivery rates increased with the score, and the delivery gestational age showed an initial increase. To optimize the ECV procedure and reduce the hospital burden, this scoring system should be used routinely to predict the ECV success rate and determine the timing of ECV attempts.

External cephalic version for breech presentation: The guideline landscape and a quest for an optimal approach

ObjectivesThe aim of this study was to illuminate differences in guidelines for external cephalic version (ECV) for breech presentation at or near term and assess their impact on effectiveness of the procedure in order to improve policymaking. Study designGuidelines from all Swedish ECV providers (hospitals with labor wards, n = 44) were retrieved in 2019 and assessed for similarities and differences. The scoring system based on the identified differences in timing, contraindications and periprocedural care was created. The hospitals were subsequently classified into either restrictive or liberal with regard to ECV. This classification was verified by comparing selection of patients for ECV attempts between the two groups. Our main outcomes were ECV success rate and effectiveness in reducing the remaining breech births and breech cesarean sections. ResultsImportant differences in timing of ECV, contraindications, periprocedural care, and counselling after failed ECV attempt were found. Two thirds of the hospitals were considered liberal and one third restrictive with regard to ECV. ECV success rate was significantly higher in hospitals with a liberal attitude towards ECV compared with restrictive hospitals (54.0 % vs 50.5 %, p = 0.015). Liberal hospitals had a significantly lower proportion of remaining breech births (2.81 % vs 3.01 %, p = 0.009) and breech cesarean sections at or near term (2.49 % vs 2.72 %, p = 0.003). ConclusionImportant differences in ECV guidelines were found. Hospitals with guidelines reflecting a liberal attitude to ECV had a higher ECV success rate, despite a less strict patient selection, and a lower proportion of breech births and breech cesarean sections, which is the aim of ECV. We recommend avoiding routine ill-founded restrictivity in ECV guidelines and support a more nuanced counselling.

Efficacy of a second external cephalic version (ECV) after a successful first external cephalic version with subsequent spontaneous reinversion to breech presentation: a retrospective cohort study.

Determining the efficacy of performance of a second external cephalic version (ECV) following successful first ECV with subsequent spontaneous reinversion to breech presentation in reducing the rate of cesarean delivery (CD). Data were reviewed on healthy women with fetuses in breech presentation who underwent a first ECV after 36weeks. Routine ultrasound study was performed at 39-week gestation, and a repeat ECV procedure was performed if the fetus had reverted to non-cephalic presentation. Obstetrical outcome measures were compared between women who underwent one successful ECV between 36- and 41-week gestation in which the fetus remained in cephalic presentation until labor and those who underwent a successful first ECV after which the fetus returned to breech and a second ECV was performed. The primary outcome was the rate of secondary CD during vaginal delivery in cephalic presentation; rate of successful second ECV was the secondary outcome. Overall 250 women underwent one ECV attempt of which 169 (67%) were successful. Of them 28 reverted to breech presentation, all women underwent two attempts of which 21 (76%) were successful. A second successful ECV attempt was associated with a 33% incidence of a CD vs. 2.8% after one successful ECV in which the fetus remained in cephalic presentation. A second ECV after a successful first ECV with subsequent spontaneous reversion to breech presentation can be expected to be successful in 76% of cases but lead to CD in 33% of cases. Our findings can be used to support patient counseling and decision-making before second ECV attempt.

Influence of the external cephalic version attempt on the Cesarean section rate: experience of a type 3 maternity hospital in France.

To define the effects of attempted external cephalic version (ECV) in a low-risk population for breech delivery in a maternity hospital where breech vaginal delivery is widely practiced. Retrospective exposed-unexposed study including 204 patients presented with a live singleton fetus breech presentation on third-trimester ultrasound and who delivered at Reims University Hospital between January 1st, 2013 and July 1st, 2018. 121 patients received ECV. Cesarean section rate was lower (OR with no adjustment 0.42 [0.24-0.76] p = 0.004) but without significant difference in the exposed patients after adjustment. This difference was significant between exposed and unexposed patients in the subgroup of 51 primiparous (OR = 0.14 [0.04-0.52] p = 0.002) and 51 multiparous (OR = 0.26 [0.08-0.89] p = 0.028) but not in the subgroup of 102 nulliparous. There was no difference in fetal impact other than neonatal management in the delivery room, which is less needed in exposed primiparous women. Attempted ECV significantly decreased the breech rate (72.5 vs 100%, p < 0.001). There were 7 (5.79%) complications. Three factors favored success: high uterine height (p = 0.011), a non-elevated BMI (p = 0.006) and an earlier term at ECV (p = 0.003). The attempt of ECV in the Reims University Hospital does not significantly reduce the Cesarean section rate and has no effect on neonatal status.

Systematic Kleihauer-Betke Test after External Cephalic Version for Breech Presentation: Is It Useful?

The incidence of fetomaternal hemorrhage (FMH) after external cephalic version (ECV) has been poorly reported. In this study, we evaluated the frequency of FMH, diagnosed by positive Kleihauer–Betke test (KBT), after ECV attempt and then evaluate the relevance of its routine use after procedure. A total of 282 women with a term breech presentation and who had ECV attempt were recruited from January 2014 and December 2018. After ECV attempt, women were systematically screened for FMH using KBT. Data on ECV attempt, KBT results, perinatal and neonatal outcomes were collected and compared between women with positive (cases) and negative KBT (controls) after ECV. The success rate of ECV was 22.0% (62/282). Eight women (2.9%) experienced transient fetal heart rate (FHR) abnormalities after ECV. In five (1.8%) women, KBT was positive after ECV. Obstetrical management was modified for two of these five women due to continuous positivity of KBT at day 1 and day 7 controls after ECV attempt. A cesarean section was planned 7 days earlier due to persistent high FMH on day 7 (6 mL fetal blood) in one woman and the labor was induced for persistent high FMH on day 7 (20 mL fetal blood) for another woman. No newborns have signs of fetal anemia at birth and there was no significant difference in neonatal status between two groups. FMH after ECV attempt are rare, and no negative fetal or neonatal outcomes were observed when KBT was positive, even strongly (>5 mL fetal blood). It appears that systematic KBT after attempted ECV is probably not useful.

The effect of transient fetal bradycardia and other heart rate changes during and after external cephalic version on perinatal outcomes

ObjectivesTo evaluate the effect of transient fetal bradycardia and other heart rate changes during and after external cephalic version (ECV) on perinatal outcomes. To determine factors associated with a higher risk of occurrence of transient fetal bradycardia during and after ECV. Study designProspective study in 286 women after the 36th week of gestation with a fetus in breech presentation who have undergone an ECV attempt. The study analyses the incidence of transient fetal bradycardia during and immediately after ECV, the time interval to complete adjustment of fetal bradycardia, the factors associated with the occurrence of transient fetal bradycardia, cardiotocography (CTG) changes after ECV and perinatal outcomes. All the data were statistically analyzed. ResultsThe ECV was successful in 51 % (146/286). Transient fetal bradycardia occurred during and after ECV in 81 cases (28.3 %). A successful version was a factor significantly associated with fetal bradycardia (54; 37.0 % versus 27; 19.3 %; p < 0.01). Clinically significant hypotension of the mother was accompanied by transient fetal bradycardia in 12 cases (4.2 %). After the successful ECV there was no significant difference in the percentage of vaginal deliveries between subgroups with and without transient fetal bradycardia (85.2 % versus 83.7 %; p = 1.00). Nor in occurrence of acute fetal distress during labor (18.5 % versus 15.6 %; p = 0.65). In cases of a successful ECV transient CTG changes after ECV had no effect on the incidence of acute fetal distress during labor (23.5 % versus 15.7 %; p = 0.49). ConclusionsTransient fetal bradycardia and other heart rate changes during and immediately after ECV was not associated with a higher incidence of acute fetal distress during labor and did not affect perinatal outcomes. Higher occurrence of transient bradycardia after ECV was associated only with successful ECV. Transient hypotension of the mother as one of the causes of transient fetal bradycardia during ECV should be considered.

An alternative to cesarean: a description of external cephalic version in noncephalic presenting twin

Objective: External cephalic version (ECV) is utilized in breech presenting singleton gestations but ECV of the noncephalic presenting twin has been considered technically unfeasible. We have successfully performed ECVs of the noncephalic presenting twin. Our objective is to describe our experience with this technique. Study design: This is a descriptive case series of our attempted ECVs in twin pregnancies and their outcomes. Results: Of 19 twin A ECV attempts, 10 cases were successful. The overall vaginal delivery rate was 42% (8/19 cases). There were no emergent cesarean deliveries required, and no neonatal injuries were observed. Conclusions: ECV can be achieved in pregnancies complicated by a noncephalic presenting twin. Further study is necessary to assess the safety and generalizability of our finding.

Does Mode of Terbutaline Administration Improve Success of External Cephalic Version? [34I

INTRODUCTION: There is a high rate of cesarean delivery (CD) for breech presentation and external cephalic version (ECV) is a means to allow for vaginal delivery and thus reduce CD. Our primary objective was to compare the success rate of ECV with subcutaneous versus intravenous (IV) terbutaline. METHODS: This was a retrospective cohort of women with singleton fetuses ≥ 36 weeks of gestation undergoing ECV at our institution from May 2007-February 2018. Our protocol from 2007-2013 included a single dose of subcutaneous terbutaline (0.25 mg) followed by ECV. From March 2013 until February 2018, our protocol was a single dose of intravenous terbutaline (0.25 mg) prior to ECV attempt. Statistical analysis included Student t test, Mann-Whitney U, chi-squared and Fisher exact as appropriate. Logistic regression was used to determine which factors affected success. RESULTS: Of the 283 patients who underwent an attempted ECV, 111 received subcutaneous and 172 received IV terbutaline. The overall success rate was 65%. The success rate was 71% in the subcutaneous group vs 61.6% in the IV group (p=0.183). Lateral position of the fetal spine (p=0.02) and increasing AFI (p<0.005) were found to be predictive of success by logistic regression analysis. Maternal age, BMI, parity, placenta location, gestational age, head position, breech time and neonatal birth weight did not influence success. CONCLUSION: We did not find a difference in success rate of ECV when terbutaline was administered subcutaneously versus intravenously. We found that lateral fetal spine position and increasing AFI were independently associated with version success.

Success rates of early versus late initiation of external cephalicversion.

To determine optimum timing of external cephalic version (ECV). A retrospective cohort study was conducted at a tertiary hospital in Israel between February 1, 2016, and July 1, 2017. Healthy primiparous women with breech presentation were offered either early ECV (35-36weeks; n=54) or late ECV (37-38weeks; n=106). Group assignment was according to the patient's preference and physician availability. The primary outcome was the rate of cephalic presentation at delivery. Secondary outcomes included rate of cesarean delivery, presentation of fetus after the first and last ECVs, and serious fetal complications. The incidence of undergoing more than two ECV attempts was 18.5% in the early ECV group and 5.6% in the late ECV group (P=0.039). The incidence of cephalic presentation after the first ECV was 72.2% in the early ECV group versus 66.0% in the late ECV group (P=0.048). By contrast, no statistically significant between-group differences were found for presentation at delivery or rate of cesarean delivery. The other outcomes were also similar. Early initiation of ECV among primiparous women increased the chance of immediate cephalic presentation; however, it had no effect on presentation at delivery or cesarean delivery rate.

149: Characteristics associated with Attempt of External Cephalic Version in the U.S. Birth Certificate Data

Malpresentation is the indication for 10-15% of cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. We could not identify prior studies that investigated characteristics associated with attempt of ECV. Our objective is to detect associations between patient characteristics and ECV attempt to identify populations that may experience barriers to ECV. Data was obtained from the National Center for Health Statistics birth certificate data from 2014-2016. We analyzed singleton, live, non-anomalous births to women with ≤1 prior CD delivered at 36-42 weeks. We reasoned that subjects who either had ECV attempt (whether successful or unsuccessful) or were non-cephalic at the time of delivery constituted an ECV eligible cohort. Subjects with incomplete data on ECV, mode of delivery, or presentation at time of delivery were excluded. We examined the association between patient characteristics and ECV attempt using logistic regression to obtain odds ratios and 95% confidence intervals. We found 10,016,394 deliveries met our inclusion criteria, of which 414,866 subjects were considered ECV eligible. Only 6.8% of the ECV eligible population had an ECV attempt. Of ECV attempts, 55.3% were successful. Of successful ECV attempts 78.6% delivered vaginally. Of total ECV attempts, 48.2% delivered vaginally; 339 of these were breech vaginal deliveries. We found that Hispanic and non-Hispanic black race, unmarried status, lack of college degree, age <24, Medicaid or self-paying status, nulliparity, and prior CD to be associated with non- attempt of ECV. Association between examined characteristics with ECV attempt are described in Table 1. Our findings are limited by quality of data collection, but strongly suggest that ECV is underutilized. Reasons for this remain unclear, but likely include both provider and patient preference. We identified characteristics associated with ECV attempt. Further investigation should focus on barriers that exist to this effective means of CD reduction. Reporting of ECV attempts in eligible patients at a hospital level could be considered a quality metric.

External cephalic version at term: a cohort study of 18years' experience.

To analyse the outcome of referrals for external cephalic version (ECV). Retrospective cohort study of prospectively collected data. Major university hospital, UK. Women with non-cephalic presentation at term and no prior caesarean, referred to a specialist clinic. Details of referrals, ECV attempts, and perinatal outcomes were prospectively collected and analysed. Multivariate binary logistic regression models were created to determine independent predictors of ECV success, reversion, and spontaneous version. External cephalic version success rates, predictors of success and cephalic presentation at birth, and perinatal outcomes. Three thousand eight had confirmed breech presentation; 2614 women underwent ECV. Ineligibility for ECV occurred in 117 breech presentations (3.9%), and 297 eligible women (10.2%) declined it. ECV was successful in 1280 (49.0%, 95% CI 47.0-50.9%) (40% in nulliparous women; 64% in others); 1234 (97.3%) were cephalic at birth. Spontaneous version after failure occurred in 4.3% and was more common in multiparas (aOR 2.47, 95% CI 1.43-4.26) and those with a posterior fetal back (aOR 6.09, 95% CI 1.90-19.53). Reversion after successful ECV occurred in 2.2%. In women with a successful ECV whose fetus remained cephalic at birth, 85.7% delivered vaginally. The corrected perinatal mortality of the ECV cohort was 0.12%. External cephalic version has a low complication rate and is effective for most breech presentations, enabling vaginal birth and avoiding caesarean section. External cephalic version can safely be performed with most breech presentations.

External cephalic version after previous cesarean section: A cohort study of 100 consecutive attempts

ObjectiveExternal cephalic version is commonly not performed in women with a previous cesarean section. Fear of uterine rupture and cesarean section in labor are prominent. The risks, however, of these are unclear. This study aims to document the safety and efficacy of external cephalic version in women with a prior cesarean section in a series of 100 consecutive attempts, and to perform a literature of the existing literature. Study designThis is a retrospective cohort study of prospectively collected data of external cephalic version attempts in women at term with a previous cesarean section, and a literature review of previously published series. External cephalic version was performed by one of 3 experienced operators, with salbutamol tocolysis if appropriate, using ultrasound to visualize the fetal heart and place of fetal parts. Results100 women with a prior cesarean section underwent external cephalic version over a 16-year period in one institution. 68% had no previous vaginal delivery. The external cephalic version success rate was 50%, and 30 (63.8%) of these subsequently delivered vaginally. There were no cases of uterine rupture or other complications. A literature review of series containing a total of 549 cases revealed no cases of uterine rupture or perinatal death. ConclusionsExternal cephalic version in women with a prior cesarean section is safe but enables a vaginal birth in only about a third of women.