Successful External Cephalic Version Research Articles

External cephalic version - single-center experience.

External cephalic version (ECV) is an alternative to caesarean section for abnormal fetal position. ECV is recommended by the most important scientific committees in the world. ECV complications are rare and occur in 6.1% of cases, however severe complications requiring urgent caesarean section are found in less than 0.4%. Our aim was to demonstrate the effectiveness and safety of ECV and to present our own experience with the procedure of ECV. ECV was performed on 62 patients (32 nulliparas and 30 multiparas). Qualification criteria included: singleton gestation, gestational age > 36 + 6, longitudinal pelvic lie, no uterine contractions, intact membranes. Indications for immediate cesarean section within 24 hours of ECV were considered a procedural complication. In patients with complications, the condition of the newborn was checked according to the APGAR score and the day of discharge of the mother and child from the maternity ward was analyzed. ECV finished successfully in 66.1% (nulliparas 56.2% and multiparas 76.7%). Patients with a successful ECV were significantly older and had higher median gestational age. ECV was more often successful when placenta was located on the posteriori wall. In our patients, there were 4 cases of complications requiring delivery at the time of ECV. No serious consequences associated with increased maternal or neonatal morbidity or mortality were reported. ECV seems to be a safe alternative for women wishing to deliver vaginally, as this procedure does not increase the risk of adverse obstetric outcomes.

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..

Undiagnosed uterine anomalies revealed by breech on ultrasound prior to external cephalic version – A chance to take a closer look

ObjectiveUterine anomalies (UA) occur in up to 6.7% of women. Breech is eight times more likely to occur with UA which may not be diagnosed prior to pregnancy and may only be found in the third trimester with breech. The objective of the study is to assess the prevalence of both already known and newly sonographically diagnosed UA in breech from 36 weeks of gestation and its impact on external cephalic version (ECV), delivery options and perinatal outcomes. Study DesignWe recruited 469 women with breech at 36 weeks of gestation over a 2-year period at the Charité University Hospital, Berlin. Ultrasound examination was performed to rule out UA. Patients with known and newly ‘de novo’ diagnosed anomalies were identified and delivery options and perinatal outcomes analyzed. ResultsThe ‘de novo’ diagnosis of UA at 36–37 weeks of pregnancy with breech was found to be significantly higher compared to the diagnosis prior to pregnancy with 4.5% vs 1.5% (p < 0.001 and odds ratio 4 with 95% confidence interval 2.12–7.69). Anomalies found included 53.6% bicornis unicollis, 39.3% subseptus, 3.6% unicornis and 3.6% didelphys. A trial of vaginal breech delivery was successful in 55.5% of cases when attempted. There were no successful ECVs. ConclusionBreech is a marker for uterine malformation. Diagnosis of UA with breech can be up to four times improved with focused ultrasound screening in pregnancy even from 36 weeks of gestation prior to ECV to identify missed anomalies. Timely diagnosis aids antenatal care and delivery planning. Importantly, definitive diagnosis and treatment can be planned postpartum to improve outcomes in future pregnancies. ECV plays a limited role in selected cases.

Impact of full vs empty urinary bladder on external cephalic version success: a randomized controlled trial

External cephalic version is a procedure used to turn a fetus from a breech position to a cephalic position before delivery. The success rate of the external cephalic version can be affected by various factors; however, the effect of bladder volume on the success rate of the external cephalic version remains controversial. This study aimed to determine the effect of urinary bladder status (full or empty) on the success rate of the external cephalic version through a prospective randomized study. This was a prospective randomized controlled trial conducted at a tertiary care obstetrical center. Overall, 70 women with a singleton breech presentation at term undergoing external cephalic version were randomly allocated into 2 groups: external cephalic version with an empty bladder and external cephalic version with a full bladder. The external cephalic version procedure was performed by experienced obstetricians under ultrasound guidance. The primary outcome was the success rate of the external cephalic version. The success rate of the external cephalic version was 67.56% (25/37) in the full bladder group and 54.54% (18/33) in the empty bladder group, with no statistically significant difference between the groups (P=.26). In addition, the relative risk of successful external cephalic version was 1.23 (95% confidence interval, 0.84-1.81), indicating no significant difference. This randomized controlled trial demonstrated that the presence of a full or empty urinary bladder does not significantly affect the success rate of the external cephalic version in women with singleton breech presentation at term. Our findings suggest that women undergoing an external cephalic version do not need to have a full bladder to improve the success rate of the procedure.

External Validation of a Prediction Model for External Cephalic Version Success.

External cephalic version (ECV) success correlates with numerous maternal and pregnancy factors. A prior study developed an ECV success prediction model based on body mass index, parity, placental location, and fetal presentation. We performed external validation of this model using a retrospective cohort of ECV procedures from a separate institution between July 2016 and December 2021. Four hundred thirty-four ECV procedures were performed, with a 44.4% success rate (95% CI 39.8-49.2%), which was similar to the derivation cohort (40.6%, 95% CI 37.7-43.5%, P =.16). There were significant differences in patients and practices between cohorts, including the rate of neuraxial anesthesia (83.5% derivation cohort vs 10.4% our cohort, P <.001). The area under the receiver operating characteristic curve (AUROC) was 0.70 (95% CI 0.65-0.75), which was similar to that in the derivation cohort (AUROC 0.67, 95% CI 0.63-0.70). These results suggest the published ECV prediction model's performance is generalizable outside the original study institution.

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 &lt; 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.

Predictive factors for successful external cephalic version with regional anesthesia.

We aimed to investigate predictive factors of successful external cephalic version (ECV) using regional anesthesia. In this retrospective study, we included women who underwent ECV at our center from 2010 to 2022. The procedure had been conducted using regional anesthesia and the administration of intravenous ritodrine hydrochloride. The primary outcome was the success of ECV, which was defined as the rotation from a non-cephalic to a cephalic presentation. Primary exposures were maternal demographic factors and ultrasound findings at ECV. To determine predictive factors, we conducted a logistic regression analysis. Of 622 pregnant women who underwent ECV, missing data on any variables (n=14) were excluded and the remaining 608 were analyzed. The success rate during the study period was 76.3%. Multiparous women had significantly higher success rates than primiparous women (adjusted odds ratio [OR]: 2.06 [95% confidence interval (CI): 1.31-3.25]). Women with a maximum vertical pocket (MVP) of <4cm had significantly lower success rates than those with 4cm < MVP ≤6cm (OR: 0.56 [95% CI: 0.37-0.86]). The non-anterior placental location was associated with higher success rates than the anterior placental location (OR: 1.46 [95% CI: 1.00-2.17]). Multiparity, MVP >4cm, and non-anterior placental locations were associated with successful ECV. These three factors could be useful for patient selection for successful ECV.

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.

TOLAC outcomes after a successful external cephalic version

Patients undergoing a trial of labor after successful external cephalic version (ECV) have lower rates of vaginal delivery. The aim of this study was to determine whether patients undergoing a trial of labor after cesarean delivery (TOLAC) after a successful ECV are at risk of poor TOLAC outcomes. A retrospective cohort study was conducted at a single university-affiliated medical centre between the years 2012-2018. Patients who underwent a TOLAC attempt after a successful ECV comprised the study group. Outcomes were compared to patients who underwent TOLAC in a vertex presentation without a history of ECV. The primary outcome was TOLAC success. Secondary outcomes included mode of delivery and adverse neonatal outcomes including 5 minute Apgar score < 7, umbilical cord pH < 7.1. Patients undergoing TOLAC with a history of 2 previous cesarean deliveries were excluded from this study. 7693 patients underwent a TOLAC attempt during the study period. 66 patients had a successful ECV and comprised the study group. Outcomes were compared to 7627 patients undergoing TOLAC who did not have an ECV. There were no significant between-group differences in maternal age (31.6± 4.6 Vs 32.4± 5.3, p< 0.19), parity (4.3±2.4 Vs 4.4±2.6 p=0.81 ), gestational age at delivery (39.4±1.2 Vs 39.4±1.4 p=0.51) or birthweight (3338.0±440.9 Vs 3364.9±442.1 p=0.69). Patients who underwent ECV were just as likely to have a successful TOLAC (87.9% Vs 93.5% OR 0.49 95%CI 0.25-1.12 p=0.07) and did not have an increased risk of operative vaginal delivery (13.6% Vs 8.4% OR 1.74 95% CI 0.8-3.4 p=0.13), 5 minute APGAR score < 7 (0% Vs 0.4% OR 0.16 95% CI 0.03-1.8 p=1.0) or umbilical cord pH < 7.1 (1.5% Vs 0.2% OR 7.6 95% CI 0.3-39.8 p=0.15) compared to the control group. TOLAC after a successful ECV is associated with a high rate of vaginal birth after cesarean (VBAC) without an increased risk of adverse neonatal outcomes.

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.

External cephalic version for a malpresenting first twin before labor: a prospective case series

In twin pregnancies where the presenting twin is not cephalic, cesarean delivery is the standard of care. External cephalic version (ECV) has been used for malpresenting singleton pregnancies with low risk of complications. ECV in twin pregnancies is poorly studied. To assess feasibility and report any complications of ECV of a malpresenting twin before labor. This is a prospective cohort of twin pregnancies with malpresenting first twin. Inclusion criteria included English or Spanish speaking women. Exclusions included cases where there was a contraindication to vaginal delivery. ECV was performed according to the institutional singleton protocol. Fetal testing of both twins was performed before and after procedure. A vaginal hand was used during ECV as needed. The primary outcome was success of the procedure. Secondary outcomes included delivery characteristics and neonatal outcomes. Five patients were enrolled in this study. Four patients underwent successful ECV and vaginal delivery occurred in 2 of the 4 patients. ECV procedure was performed at a mean gestational age of 36+0 weeks in the successful ECV group and 36+6/7 weeks for the unsuccessful group. Latency to delivery was 4.5 days in the successful ECV group and 1 day in the unsuccessful ECV group. No maternal or neonatal complications occurred in any participating women. ECV in twin pregnancies where the first twin is malpresenting was feasible in our cohort. More research is needed to better characterizer the safety and efficacy of this procedure in this patient population.

Factors influencing the effect of external cephalic version: a retrospective nationwide cohort analysis.

This study aims to assess the factors associated with the success and failure rate of the external cephalic version (ECV) in breech fetuses. Secondary outcomes were fetal presentation in labor and mode of delivery. This cross-sectional study examined the live birth certificates from 2003 through 2020 from US states and territories that implemented the 2003 revision. A total of 149,671 singleton pregnancies with information about ECV success or failure were included. The outcome was ECV success/failure, while the exposures were possible factors associated with the outcome. The successful ECV procedures were 96,137 (64.23%). Among the successful ECV procedures, the prevalence of spontaneous vaginal delivery was 71.63%. Among the failed ECV procedures, 24.74% had a cephalic presentation at delivery, but 63.11% of these pregnancies were delivered by cesarean section. Nulliparity, female sex, low fetal weight centile, high pre-pregnancy BMI, high BMI at delivery, and high maternal weight gain during pregnancy were associated with an increased ECV failure (p < 0.001). African American, American Indian and Alaska Native race categories were significant protective factors against ECV failure (p < 0.001). Maternal age had a U-shape risk profile, whereas younger maternal age (< 25years) and old maternal age (> 40years) were significant protective factors against ECV failure (p < 0.001). A high prevalence of successful ECV procedures and subsequent spontaneous vaginal delivery were found. The present results found nulliparity, maternal race, maternal age, female fetal sex, low fetal weight, and maternal anthropometric features correlated to ECV results. These findings can potentially improve the knowledge about the factors involved in ECV, allowing more informed counseling to the women undergoing this procedure.

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.

Ritodrine in external cephalic version: is it effective and safe?

ObjectiveThe external cephalic version (ECV) has been shown to lower the likelihood of cesarean section requirements among pregnant women with breech presentations. In the current study, we investigated the effectiveness and safety of ritodrine as a tocolytic for ECV.MethodsA total of 407 pregnant women with breech presentations, who had no contraindications for ECV, were enrolled in this study. Multivariable logistic regression analyses were used to assess the impact of ritodrine use on the safety and efficacy of ECV.ResultsThe overall success rate was 67.6%, and ritodrine use was associated with significantly higher odds of successful ECV after adjusting for confounders. Moreover, using ritodrine did not increase the risk of adverse effects, including temporary changes in fetal heart rate, need for elective or emergency cesarean section due to fetal distress during ECV, low Apgar scores, and perinatal mortality.ConclusionOur results suggest that using ritodrine as a tocolytic during ECV may increase the likelihood of ECV success and may not increase adverse perinatal outcomes.

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.

Comparison of Materials used in Facilitating External Cephalic Version

Introduction: External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce the number of assisted breech deliveries and caesarean sections for breech presentation. Talcum powder or aqueous gel is frequently used to facilitate ECV. We compared powder with gel in attaining a successful version and level of practitioner satisfaction with powder versus gel use.Materials and Methods: This retrospective descriptive study was conducted by Wah Medical College in POF hospital (affiliated with WMC) , Wah Cantt from 10th Oct 2015- 10th Oct 2019. Total of 56 low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using convenient consecutive sampling, powder or gel during ECV was allocated accordingly. ECV was performed by the single experienced practitioner in labour room with cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining a successful version. ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECVs were reattempted with crossover use to the other aid. Practitioner satisfaction was defined as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while using powder or gel during ECV. The data was recorded &amp; analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version &amp; practitioner satisfaction level with powder versus gel use.Results: In the powder use group, 9 ECVs were successful and 19 ECV’s were unsuccessful. In gel use group, 12 ECVs were successful and 16 were unsuccessful. There were more successful ECV’s in gel group but the association was not significant (P-value .408). Practitioner satisfaction was significantly high with gel than the powder use(P-value .&lt;.001).Conclusion: Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice.

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.

399 Effectiveness and safety of external cephalic version as a method of reducing cesarean sections rates

Introduction: Breech position is a common indication for caesarean section. Elective caesarean section is the mode of choice in this group of patients. RCOG recommends proposing an external cephalic version (ECV) to each patient with a pelvic presentation in a full-term pregnancy in whom no absolute contraindications for external cephalic version and vaginal delivery have been demonstrated. The procedure of external cephalic version is a minimally invasive method, safe for mother and fetus, and yet it is used only a in few centers in Poland. Lack of popularity likely results from the low awareness of patients and limitations in availability of this procedure. Aim of the study: To assess effectiveness and safety of external cephalic version in reducing cesarean sections rates. Methods: This was a retrospective analysis of electronic medical records of patients that requested and were qualified for an external cephalic version. All patients signed an informed consent to undergo the procedure. Results: In 2017-2020, 70 patients were qualified for an external cephalic version. 6 of them had caesarean section before. The success rate was 49%, which is the world average (50%) in terms of the effectiveness of this method. Success rate in the studied group after one caesarean section was 66,7 %. After successful external cephalic version, 26 patients (84%) delivered vaginally, including 3 patients (50%) after cesarean section. 4 patients had an emergency caesarean section (16%). Conclusions: Although ECV is effective in only 50% of cases, we observed a high percentage (84%) of vaginal deliveries after successful ECV. Therefore, we can demonstrate a 37% decrease in elective cesarean section rate among patients with pelvic presentation in the study group. Popularization of ECV among obstetricians and patients seems to be the optimal method of reducing elective cesarean sections rate for breech presentation.