Objective To determine if external cephalic version (ECV) can be performed with safety and efficacy in women with previous caesarean section.Design Prospective comparative cohort study. Setting Cruces University Hospital (Spain).Population Single pregnancy with breech presentation at term. Main outcome measures Success rate, complications of the ECV and caesarean section rate.Results The success rate of ECV in women after previous caesarean section was 67.1% versus 66.1% in multiparous women (P = 0.87). The logistic regression analysis confirmed this result (odds ratio 0.93, 95% CI 0.52-1.68; P = 0.82) adjusted by the variables associated with success of ECV. There were no complications in the previous caesarean section cohort. The vaginal delivery rate in the previous caesarean section cohort was 52.8% versus 74.9% in the multiparous cohort (P < 0.01). There were no cases of uterine rupture.Conclusion Based on our data, we conclude that complications are uncommon with ECV in women with previous caesarean section, with a success rate comparable to that of multiparous women. Uterine scar should not be considered a contraindication and ECV should be offered to women with previous caesarean section with breech presentation at term.

Management of breech presentation with a protocol that includes ECV, careful selection criteria and active management of vaginal delivery achieve a great decrease in the rate of CS for breech presentation.

A score composed of four easily measurable variables enabled us to predict the outcome of ECV at term.

The induction of labour during week 41 in prolonged pregnancies may increase the rate of caesarean sections in hospitals with low rates of caesarean sections.

Following ECV, induction of labor, an interval of less than 2 weeks to delivery, BMI, and previous cesarean were associated with an increased risk of cesarean.