BACKGROUND AND PURPOSE:

• External cephalic version (ECV) is recommended to reduce malpresentation at term in the appropriate clinical situation when there are no contraindications
• There is limited data regarding perinatal outcomes when comparing an ECV attempt to expectant management (i.e., planned cesarean for fetal malpresentation)
• Son et al. (Obstetrics & Gynecology, 2018) assessed perinatal morbidity and mortality in women undergoing an ECV attempt vs expectant management

METHODS:

• Retrospective cohort study
  • Women ≥37 weeks
  • Nonanomalous singleton gestation
  • Fetal malpresentation: Complete breech | Frank breech | Footling breech | Transverse
• Women either underwent
  • ECV attempt at ≥37 weeks
  • Expectant management at ≥37 weeks
• ECV procedure
  • Neuraxial analgesia
  • one dose of 0.25 mg terbutaline subcutaneously prior to ECV
  • Continuous fetal heart monitoring
• Primary outcome: Composite of perinatal morbidity and mortality
• Secondary outcomes: NICU admission and neonatal anemia (nadir Hgb <13.5 g/dL in first 28 days)

RESULTS:

• 4,117 were included in the study
  • 1263 were in the ECV group
  • Fewer than 1/3 of eligible women underwent ECV
  • 40.3% had successful versions
  • 79% ultimately delivered vaginally
• Women who underwent attempted ECV were more likely to be non-Hispanic white and multiparous with lower BMI
• Perinatal morbidity and mortality did not differ between groups (P=.46)
  • 2.9% in the ECV group vs 2.5% in the expectant management group
  • adjusted odds ratio 1.02; 95% CI 0.66–1.60
• Neonatal outcomes did not differ between groups
  • NICU admission: 3.6% in the ECV group vs 3.3% in the expectant management group (P=.53)
  • Neonatal Anemia: 1.6% in the ECV group vs 1.2% in the expectant management group (P=.36)

CONCLUSION:

• Composite perinatal outcomes and newborn outcomes were not different between ECV attempt group and expectant management
• Cesarean sections were reduced due to ECV attempt
• The authors state that these findings support guidance to attempt ECV for fetal malpresentation at term

Learn More – Primary Sources:

Association Between Attempted External Cephalic Version and Perinatal Morbidity and Mortality

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VBAC Guidelines: Who is a Candidate for a Trial of Labor after Cesarean Delivery?