External Cephalic Version—A Chance for Vaginal Delivery at Breech Presentation

Abstract

Background and Objectives: In recent years, the rate of caesarean section (CS) has increased constantly. Although vaginal breech delivery has a long history, breech presentation has become the third most common indication for CS. This study aims to identify factors associated with the success of external cephalic version (ECV), underline the success rate of ECV for breech presentation and highlight the high rate of vaginal delivery after successful ECV. Material and Methods: This retrospective observational study included 113 patients with singleton fetuses in breech presentation, who underwent ECV from January 2016 to March 2021 in the Clinic of Obstetrics and Gynecology, Diakonieklinikum Schwäbisch Hall, Germany. Maternal and fetal parameters and data related to procedure and delivery were collected. Possible predictors of successful ECV were evaluated. Results: The success rate of ECV was 54.9%. The overall rate of vaginal birth was 44.2%, regardless of ECV outcome. The vaginal birth rate after successful ECV was 80.6%. Overall, 79.0% of women with successful ECV delivered spontaneously without complications, 19.4% delivered through CS performed during labor by medical necessity, and 1.6% delivered through vacuum extraction. ECV was performed successfully in three of the four women with history of CS. Gravidity, parity, maternal age, gestational age, fetal weight, and amniotic fluid index (AFI) were significantly correlated with the outcome of ECV. Conclusions: ECV for breech presentation is a safe procedure with a good success rate, thus increasing the proportion of vaginal births. Maternal and fetal parameters can be used to estimate the chances of successful ECV.

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

“…If we could try an ECV with NA for a second attempt after a failed ECV attempt, the success rate and a reduction of Cesarean delivery could be calculated again. In a study performed by Cobec et al [18], the CD rate among participant with successful ECV was 19.4%, while in ours was 6.72%. So, we may attempt to conduct this trial.…”

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

“…Of these articles, two were from the same team of authors and used the same dataset; Anand et al used the dataset to create a model predicting cephalic position after the ECV, while the Palepu et al created a model to predict vaginal delivery 34,35 . The remaining 11 articles were completely independent from each other; two of these articles proposed two models each 36,37 , while the remaining 9 proposed a single model each [38][39][40][41][42][43][44][45][46] (Figure 2). Two of the articles had an erratum: one was trivial 40,47 and only modi ed a sentence in the abstract, while the other was a correction of a gure describing the decision tree model 41,48 .…”

“…The results of the study quality assessment based on the signaling questions are shown in Table 4. Out of 17 new articles, 10 studies were identi ed as having low overall risk of bias and high study quality 22,[33][34][35][36]39,41,[44][45][46] , 6 studies were identi ed as having moderate bias and moderate study quality 29,37,38,42,43,47 , and 1 was considered to have high bias and low quality 30 . This is in addition to Velzel et al's assessment of the 8 prior articles of which 4 were low risk of bias and high study quality and 4 were moderate risk of bias and study quality 10 .…”

“…The model types, level development, and model performance are shown in Table 6, 13 models (from 12 articles) of the 25 models were only at the model derivation stage and had no internal or external validation 24,30,32,35,37,38,40,[42][43][44][45]49 . 7 models (from six articles) had internal validation by either random split, bootstrapping, and/or cross-validation, but had no form of external validation 24,33,34,36,41,46 .…”

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

“…Of these articles, two were from the same team of authors and used the same dataset; Anand et al used the dataset to create a model predicting cephalic position after the ECV, while the Palepu et al created a model to predict vaginal delivery 34,35 . The remaining 11 articles were completely independent from each other; two of these articles proposed two models each 36,37 , while the remaining 9 proposed a single model each [38][39][40][41][42][43][44][45][46] (Figure 2). Two of the articles had an erratum: one was trivial 40,47 and only modified a sentence in the abstract, while the other was a correction of a figure describing the decision tree model 41,48 .…”