Success Rate Of External Cephalic Version Research Articles

EXAMINING PREGNANCY OUTCOMES AFTER EXTERNAL CEPHALIC VERSION FOR BREECH PRESENTATION

External cephalic version (ECV) is a non-invasive procedure performed to reposition a breech fetus into the cephalic position before labor, thus reducing the risk of cesarean delivery. This study aims to examine pregnancy outcomes following external cephalic version for breech presentation. A retrospective analysis of maternal and neonatal outcomes was conducted among women who underwent ECV for breech presentation at a tertiary care center over a specified period. Data on the success rate of ECV, mode of delivery, neonatal outcomes, and maternal complications were collected and analyzed. The findings provide insights into the safety and effectiveness of ECV in improving pregnancy outcomes for women with breech-presenting fetuses.

Success Rate and Clinical Outcomes of External Cephalic Version with or without Anesthesia for Breech Presentation at Term in China

Background: To determine whether neuraxial anesthesia (NA) can improve the success rate of external cephalic version (ECV), and evaluate the clinical outcomes. Methods: This study included 201 consecutive participants who had a breech presentation at term and received ECV between 2014 and 2022. Participants who received ECV without NA were included in Group 1, while participants with NA were included in Group 2. Outcomes assessed were the success rate of ECV and clinical outcomes. Results: In total, 201 participants who had a breech presentation at term and received ECV met the inclusion criteria. Totally, 134 participants performed ECV without NA were included in Group 1, while 67 participants performed the ECV with NA were included in Group 2. The success rate of ECV among the participants was 66.2% (133/201). The rate of placental abruption during or after ECV and neonatal intensive care unit (NICU) admission in Group 2 was statistically significant higher than in the Group 1 (p < 0.05). Conclusions: This study suggested that the use of NA did not increase ECV success rates after 37 weeks of gestation. The recommendation of NA for the ECV may be not suitable for all pregnancies unless the participants request. A large and high-quality study should be conducted to verify the role of NA in ECV, if any.

External cephalic version success rate and associated factors: Experience from a tertiary center in Sub-Saharan Africa: A cross-sectional study.

To determine the success rate of external cephalic version (ECV) and its associated factors in an Ethiopian setting. A total of 152 ECVs performed at the St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia from June 1, 2018, up to March 30, 2019, were analyzed, using a prospective cross-sectional study design. Data were analyzed using SPSS version 21. Chi-square test of association was applied for categorical data analysis. Multivariate logistic regression analysis was used to determine predictors of success of ECV. Odds ratio, 95% CI, and P-value<0.05 were used to describe findings' significance. The success rate of ECV was 71.7%. ECV success rate did not differ between multiparous and nulliparous (AOR = 1.4, 95% CI 0.07-2.35), according to abdominal wall thickness status (AOR = 3.5, 95% Cl 0.29-42.40), and between unengaged and engaged presenting part (AOR = 1.1, 95% CI 0.26-4.74). A posterior placenta was associated with ECV success compared to anterior placenta (AOR = 1.14, 95% CI 1.03-2.60). Likewise, cases that experience no pain was associated with a higher ECV success rate (AOR 14.68, 95% CI 1.65-34.97). Soft uterine tone was also associated with a higher success rate compared to tense uterine tone (AOR = 3.89, 95% CI 0.02-0.39). Eighty-four percent of those mothers who had successful ECV had spontaneous vertex vaginal delivery. The success rate of ECV in this study is found to be 71.7%, which is higher than reports from previous studies. Absence of pain during the procedure, posterior placenta, and soft uterine tone were associated with successful ECV.

Role of individual provider in success of external cephalic version

External cephalic version (ECV) decreases cesarean delivery for malpresentation. However, the procedure is successful in only 50% of patients. Prior attempts to predict ECV success have focused on patient factors. The role of the individual provider has not been well studied. The objective of this study was to evaluate the association between ECV provider and success rates while controlling for patient factors. We conducted a retrospective cohort study of all ECVs performed at a single academic hospital between July 2016 and December 2021. Patients who had ECVs by providers who performed at least 8 ECVs (median) during this time were included. Our primary outcome was a fetus in a vertex presentation following ECV. Patient and provider characteristics were compared between those with a successful and unsuccessful ECV with t-tests and Chi-square tests. We applied a previously published prediction model for ECV success to our entire population, which only contained patient factors (BMI, parity, placental location, and fetal presentation). We then compared this to a model with those factors and a fixed-effect for the performing provider. Delong’s test was used to compare area under the ROC curves. There were 354 ECVs included in the study with an overall success rate of 45.2%. Twenty providers were included, performing a median 16 ECVs during the study period (IQR 9-18.5). Individual provider ECV success rates ranged from 12 – 70%. The model for ECV that used patient factors produced an AUC of 0.70 (95% CI 0.65-0.75). With the fixed-effect term for provider, the AUC improved to 0.77 (95% CI 0.72-0.81), p=0.002. After accounting for patient characteristics, the incorporation of individual providers improved a prediction model for ECV success. This suggests individual providers have an impact on a patient’s chance of a successful ECV. Future investigations should focus on identifying characteristics and techniques of providers with high success rates that could be translated into educational or simulation programs for providers seeking to improve their success rates.

Effect of Super-Specialization in External Cephalic Version: A Comparative Study

Background: The introduction of an experienced dedicated team is not a completely studied fact. Several studies reported a high external cephalic version (ECV) success rate when the procedure is executed by a single operator or a dedicated team. This study aims to compare the effectiveness and safety of the ECV when the procedure is performed by senior experienced obstetricians or by super-specialized professionals who composed a dedicated team. Methods: Longitudinal retrospective analysis of ECV performed in a tertiary hospital. From 1 January 2018 to 1 October 2019, ECV were performed by two senior experienced obstetricians who composed the dedicated team for ECV, designed as Group A. From 1 October 2019 to 31 December 2019, ECV was performed by two seniors obstetricians, designed as Group B. Ritodrine was administered during 30 minutes just before the procedure. Propofol was used for sedation. Results: 186 pregnant women were recruited (150 patients in group A and 36 patients in group B). ECV success rate increased from 47.2% (31.7–63.2) in Group B to 74.0% (66.6–80.5) in Group A (p = 0.002). The greatest increase in the success rate of ECV was seen in nulliparae, from 38.5% (21.8–57.6) in group B to 69.1% (59.4–77.6) (p = 0.004). Complications rate decreased from 22.2% (11.1–37.6) in Group B to 9.3% (5.5–14.8) in Group A (p = 0.032). Conclusions: The introduction of an experienced dedicated team improves ECV success rate, especially in primiparas, and it also reduces ECV complications rate.

Maternal race/ethnicity impacts the success ratesof external cephalic version (ECV) in the United States.

Racial and ethnic disparities in obstetrics are prevalent in the United States (US). We aimed to assess whether the success rate of external cephalic version (ECV) is affected by maternal race/ethnicity. We conducted a retrospective analysis based on the CDC Natality Live Birth database for 2016-2018. We compared the success rates of ECV across US pregnant women of different racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asians, and Hispanics) using the Pearson chi-square test and used multivariate logistic regression to control for confounding variables. Statistical signiciance was determined as p<0.05 and results were displayed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Of the 11,150,527 births, 26,255 women underwent an ECV and met inclusion criteria. The overall ECV success rate was 52.75% (13,850 women). Non-Hispanic Blacks had the highest ECV success rate (64.52%), followed by Hispanics (59.21%) and non-Hispanic Asians (55.51%). These rates were significantly higher than those of non-Hispanic Whites (49.27%, p<0.001). Non-Hispanic Blacks were associated with the highest success rate compared to non-Hispanic Whites (adjusted OR 1.95, 95% CI 1.77-2.15). The success rate of ECV varies among different maternal racial/ethnic groups. Non-Hispanic White women have the lowest ECV success rate, while non-Hispanic Black women have the highest ECV success rate.

A prospective study using an individualized nomogram to predict the success rate of external cephalic version

To establish a clinical-based nomogram for predicting the success rate of external cephalic version (ECV) through a prospective study. This was a single-center prospective study that collected eligible breech pregnant women. 152 participants were enrolled in the training cohort, who received ECV procedures performed by a single operator. We used the training cohort to establish regression equations and prediction models. These variables include maternal factors (age, operation gestational age, pre-pregnancy BMI (Body Mass Index), operation BMI, BMI increase, multipara), ultrasound factors (fetal weight estimation, amniotic fluid index, placental location, type of breech presentation, spinal position), and anesthesia. Univariate and multivariable analyses were used to screen the factors affecting the success of ECV. A nomogram scoring model was established based on these factors. And C-index, DCA (Decision Curve Analysis) and calibration curve, Hosmer–Lemeshow test was used to verify the prediction effect of the model. Finally, 33 participants were enrolled in the testing cohort who received ECV with an unrestricted operator. We used C-index, DCA (decision curve analysis), and Hosmer–Lemeshow to verify the application value of the prediction model. The calibration curves and ROC curves of both the training cohort and testing cohort are plotted for internal and external validation of the model. The ECV success rate of the training cohort was 62.5%. Univariate analysis showed that the predictors related to the success rate of ECV were age, BMI increase value, AFI (amniotic fluid index), breech type, placental location, spinal position, anesthesia, and multipara. The prediction thresholds of the corresponding indexes were calculated according to the Youden index. Multivariate logistic regression analysis showed that BMI increase ≥ 3.85 kg/m2, AFI ≥ 10.6 cm, anesthesia, multipara, and non-anterior placenta were independent predictors of ECV success. Through the internal and external validation, it is confirmed that the model has a good calibration and prediction ability. Our nomogram has a good ability to predict the success rate of ECV.

Tocolyse lors des Versions par Manœuvres Externes (VME) : étude rétrospective avant/après dans une maternité de type III

ObjectiveOn January 2020, the French College of Gynecologists and Obstetricians (CNGOF) issued new Clinical Practice Guidelines (CPG) “Breech Presentation”. Since then, it is recommended to use a tocolytic agent to improve the success rate of External Cephalic Version (ECV). The aim of this study, one year after these CPG, is to compare ECV without (before CPG) and with (after CPG) tocolysis in a type III maternity hospital. We intend to assess its effects on immediate success rate of ECV and obstetrical and neonatal outcomes. Materials and methodsThis is a single-center retrospective study conducted in Nantes University Hospital. We collected patient characteristics, immediate success rate, and maternal and neonatal outcomes at delivery of all ECV over two periods: the first one during 2019 (before CPG) and the second one from June 2020 to June 2021 (after CPG). ResultsWe included 253 patients: 126 in the first period and 127 in the second period. Immediate success rate of ECV was significantly higher since the use of tocolysis: 38.6 % (period 2) vs 23.8 % (period 1) (P=0.011). However, there was not significant difference found for cephalic presentation at birth, mode of delivery or obstetrical and neonatal outcomes. ConclusionThe immediate success rate is significantly improved with the widespread use of tocolysis during ECV, with no change in obstetrical and neonatal outcomes.

Management and outcomes of breech presentation at term in Thailand: a systematic review and meta-analysis

There is a continuous debate on the management of term breech presentation (TBP) regarding the mode of delivery. Limited information about TBP and an absence of Thai national guidelines have led to differences in practices for the mode of delivery. This study aims to describe term breech management in Thailand, including the percentage of TBP and mode of delivery, external cephalic version (ECV) outcomes, and maternal and neonatal outcomes following cesarean section (CS) and vaginal breech birth (VBB). A comprehensive electronic database search was performed in MEDLINE, CINAHL, EMBASE, BNI, MIDIRS, CENTRAL, Scopus, PubMed and HINARI, ThaiJO and J Med Assoc Thai. All databases were searched for updates up to the 7th of April 2021 and reference lists of relevant studies were searched. Inclusion criteria consisted of primary studies assessing the management of TBP, including ECV (≥36 weeks’ gestation) and mode of delivery at term (≥37 weeks’ gestation); and studies that observed maternal or neonatal outcomes following mode of breech delivery in Thailand. The NICE methodology checklist for cohort studies was utilized to assess the risk of bias in individual studies. To synthesise the findings, a combination of meta-analysis and narrative synthesis was utilised, based on the research questions and data of the included studies. Ten studies with a total of 5112 women were included. TBP represented 89.78% of all breech deliveries in Thailand. The average success rate of ECV was high at 70%, with few complications reported and a CS rate reduction, although only in two small studies. Within the VBB group when compared with CS, the pooled estimates of neonatal outcomes including 1- and 5-minute Apgar score, birth trauma, NICU admission, neonatal death and subgroup perinatal death, showed higher risks, with only neonatal jaundice being lower. Maternal outcomes including puerperal fever and postpartum haemorrhage, indicated a lower risk following VBB compared to CS.

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&lt;.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.

Evaluating the Effect of Neuraxial Analgesia on External Cephalic Version Success

Background: External cephalic version (ECV) can be a helpful procedure in attempts to decrease the overall cesarean section rate. ECV involves the application of external pressure to the pregnant woman’s abdomen in attempts to turn the fetus to a vertex presentation and allow for subsequent vaginal delivery. Tocolytics are routinely used to increase ECV success rates, and neuraxial analgesia has been presented as another adjunct to increase overall success. The purpose of this quality improvement project is to evaluate the effect neuraxial analgesia may have on ECV success rates. Methods: Patients scheduled for ECV between the dates of January 2020 and September 2021 were reviewed. Data collected includes patient age, BMI, gestational age, success of ECV and use of neuraxial analgesia (epidural anesthesia). Results: Of the 21 patients, 6 (29%) were found to be vertex on their scheduled ECV date. Six (29%) patients who did not have an epidural failed ECV. Four (19%) patients who had an epidural failed ECV. Five (24%) patients who had an epidural had a successful ECV. Interestingly, no patients had a successful ECV without an epidural. Conclusion: No attempts at ECV were successful without an epidural in the 21 patient charts reviewed. Further evaluation through expanded chart review to increase the sample size would allow for meaningful statistical evaluation of this salient finding.

Ritodrine versus salbutamol for external cephalic version.

Treatment with beta-agonist tocolytics preceding external cephalic version (ECV) attempt increases success rates. Most studies have focused on intravenously and orally administered beta-agonists, while other administration routes including intramuscularly (IM) and subcutaneously (SC) are understudied. The aim of this study was to compare the efficacy of IM ritodrine to SC salbutamol given prior to ECV. A retrospective study of patients who underwent ECV between 1/2012 and 12/2019 at two medical centers. We compared patients undergoing ECV following IM ritodrine versus SC salbutamol. We matched the two groups by parity and placental location. Maternal, pregnancy, ECV procedure and neonatal characteristics were compared. Overall, 601 women were included in each group. Median maternal age and amniotic fluid index (AFI) were lower in the Ritodrine group (27 vs. 32 years, P<0.001, 11 vs. 15 AFI cm, P<0.001, respectively). The median gestational age at ECV was higher in the Ritodrine group (380/7 vs. 370/7 weeks gestation). Success rate was higher in the Ritodrine group (71.7% vs. 63.8%, P=0.003). Vaginal delivery rate was higher in the Ritodrine group (70.7% vs. 60.1%, P<0.001). The number needed to treat to benefit was 10. In a multivariate analysis, Ritodrine was independently associated with higher ECV success rates as compared with Salbutamol (aOR 2.1, 95%CI 1.52-2.89). Intramuscular ritodrine significantly improved the success rate of ECV compared to SC salbutamol, and both drugs were safe and acceptable before ECV.

Effect of nitrous oxide use on external cephalic version success rate

Several adjuvant interventions have been evaluated for improving the success rate of external cephalic version (ECV) and reduce the rate of cesarean delivery (CD). Evidence regarding the effect of Nitrous oxide is limited to a small number of participants with inconsistent results on pain score and success rate. This study aims to examine the effect of inhaled nitrous oxide on the success rate and pain score for women undergoing ECV.

The Charité external cephalic version for leading twin breech without regional anesthesia and tocolysis. A prospective study on feasibility, sonographic assessment and outcomes

ObjectivesTo assess the feasibility of external cephalic version (ECV) for the leading twin (twin A) in breech presentation in dichorionic and diamniotic twin pregnancies without the use of regional anesthetics and tocolysis and to characterize the sonographic parameters, maternal and neonatal outcomes. Study designProspective study performed in the Charité University Hospital outpatient obstetric department in Berlin, Germany. A total of 23 women from the 35th completed week of pregnancy with confirmed dichorionic-diamniotic twin pregnancy were recruited. ECVs were performed by the lead consultant for the breech and ECV clinic. Ethical approval provided by the Charité Ethics Commission (EA2/241/18). Demographic data were recorded. Fetal sonographic parameters were assessed. The success rate of ECV, duration of the ECV, gestational age at delivery, mode of delivery for both fetuses, maternal and neonatal outcomes were analyzed. ResultsOur main finding showed that ECV for twin A breech in dichorionic-diamniotic twins is successful in 56% (10/18) of cases without the need for regional anesthesia and without tocolysis. There is a significant increase in the spontaneous vaginal delivery rate for both twins of 95% (19/20) vs 12.5% (2/16) (p < 0.001). There is also a significant reduction in blood loss at delivery of 300 ml vs 500 ml (p = 0.034) in successful cases. ConclusionsWe show that ECV for twin A in breech is feasible and in 56% (10/18) successful without regional anesthesia and tocolysis. The option of ECV for twin A breech should be offered to women.

Success rate of external cephalic version in relation to the woman's body mass index and other factors-a population-based cohort study.

The aim of this study was to evaluate the impact of women's body mass index (BMI) on the probability of a successful external cephalic version (ECV). A retrospective population-based observational study including all women that underwent an ECV in the southeast region of Sweden from January 2014 to December 2019. Data were collected from electronic medical records, Obstetrix, Cerner. The women were divided into BMI categories according to the World Health Organization classification. Women with a BMI below 25kg/m2 formed the reference group. Crude and adjusted odds ratios for unsuccessful ECV in each BMI group were calculated using binary logistic regression. Furthermore, the association between maternal characteristics and clinical and ultrasound variables at the time of the ECV and unsuccessful ECV was evaluated. A total of 2331 women were included. The overall success rate of ECV was 53.4%. Women with a BMI below 25kg/m2 had a success rate of 51.3% whereas obese women had a success rate of 58.6%. The risk of an unsuccessful ECV among obese women (BMI ≥30kg/m2 ) had an OR of 0.74 (95% CI 0.59-0.94) compared with women with a BMI below 25kg/m2 . After adjusting for suitable confounding factors, the association was no longer significant. Higher maternal age, multiparity, higher gestational age, posterior placenta position, polyhydramnios and higher estimated weight of the fetus at the ECV significantly decreased the risk of an unsuccessful ECV. Maternal obesity does not seem to negatively influence the success rate of ECV. This is a finding that may encourage both caregivers and obese pregnant women to consider an ECV and so avoid a planned cesarean section for breech presentation in this group.

Assessment of the Successful External Cephalic Version Prognostic Parameters Effect on Final Mode of Delivery.

AimThis study aims to evaluate the prognostic parameters of successful approach for an external cephalic version (ECV) procedure by considering the vaginal delivery as the optimal mode of delivery.MethodologyA retrospective cohort study was done during June 2019 in the obstetrics and gynecology department at King Abdulaziz University Hospital. Data were collected between May 2009 and May 2019 and included all pregnant women who were candidates for the ECV. The primary objective was to assess the final mode of delivery in relation to the outcome of ECV followed by the secondary objective which was the prognostic parameters of the ECV procedure (body mass index, amniotic fluid index, parity, estimated fetal weight). Additional variables were maternal age, placental position and ethnicity.ResultsWe have studied 86 pregnant women with ECV attempts the overall ECV success rate was for 46 women (59.7%). For the final mode of delivery, after a successful ECV procedure, 40 women (87%) whom had spontaneous vaginal delivery, in association to successful ECV, the prognostic parameters recorded the highest success rate were multiparous 35 (76.1%), body mass index between 25 and 29.9 (53.1%), women older than 30 years old (60.9%), gestational age between 37 to 39.6 weeks (56.5%). Posterior placental location 55.6%, estimated fetal weight more than 2500 (73.9%).ConclusionSuccessful ECV cases have recorded a significant increase in the incidence of spontaneous vaginal delivery and the outcome of ECV which is affected by many prognostic parameters such as parity, maternal age, gestational age, body mass index, amniotic fluid index (AFI) and estimated fetal weight (EFW).

Safety and efficacy of external cephalic version after a previous caesarean delivery: A systematic review.

External cephalic version (ECV) is a common procedure and has been shown to be safe and effective in turning a baby from a breech to cephalic presentation. However, whether ECV is safe and effective in women with a scarred uterus from a previous caesarean section remains contentious. To evaluate the safety and efficacy of external cephalic version in women with a singleton breech pregnancy and at least one previous caesarean delivery. Literature searches were conducted on MEDLINE, PUBMED, EMBASE, CINAHL and SCOPUS up to June 2020. The search strategy included the following keywords: ('external cephalic version OR ECV') AND ('previous OR prior OR past' AND 'caesarean OR caesarean OR uterine scar'). Studies were included if they evaluated the efficacy and/or safety of external cephalic version in women after 36 weeks' gestation with a singleton breech pregnancy and at least one previous caesarean delivery. Nine studies were included in the review. ECV success rates and subsequent vaginal delivery rates ranged from 50 to 100% and from 50 to 74.9%, respectively. ECV complications reported included abnormal fetal heart rate, abnormal cardiotocography and transient vaginal bleeding. No studies reported cases of uterine rupture. ECV in women with a previous caesarean delivery is a relatively successful and low-risk procedure compared to women without a previous caesarean delivery. The results from this systematic review provide useful information for professional bodies in updating clinical guidelines such that ECV may be offered to women with one previous caesarean delivery.

External cephalic version: Predictors for success

ObjectivesThe objective of this study was to identify the factors predictive of the success of external cephalic version (ECV). MethodsA single-centre retrospective observational study was performed in the maternity ward of the Angers University Hospital, France, between January 2010 and May 2020. The study included all patients (n = 613) for whom an ECV was performed for a breech or transverse foetus. The primary endpoint was measured by the success of the ECV, defined by the visualisation, using pelvic ultrasound, of the foetus in cephalic presentation immediately after the manoeuvre. Following to the ECV, the cohort was separated into two groups; ECV Success and ECV Failure. In order to determine the predictive factors of success, a logistic regression model was performed, including the parameters of: parity, foetal presentation during ECV, the side of the foetal back, placental location, type of operator and maternal age.The results are presented as (odds ratio [confidence intervals]; p-value). The significance threshold was defined by a p-value < 0.05. ResultsThe ECV success rate was 21.4% (131/613). The factors predictive of the success of ECV were: transverse foetal presentation (2.7 [1.3–5.6]; p<0.01); a senior physician operator (1.6 [1.2–2]; p<0.01); multiparity (1.6 [1.2–2]; p<0.01); non anterior placental localization (1.4 [1.1–2]; p<0.01). A number of attempts greater than 3 were significantly associated with reduced chances of success (0.3 [0.2–0.4]; p<0.01). ConclusionThe study shows that transverse foetal presentation, a senior physician operator, multiparity, as well as a non-anterior placental location are factors predictive of the success of ECV. Knowledge of these factors can improve the information given to patients.

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)