Uptake of external cephalic version for term breech presentation: an Australian population study, 2002–2012

Abstract

BackgroundThe safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012.MethodsData from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks’ gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined.ResultsIn N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV. Compared to women who were eligible but who did not attempt ECV, those who had ECV were more likely to be older, multiparous, overseas-born, public patients at delivery, and to deliver in tertiary hospitals in urban areas (p < 0.01). Fewer women who underwent ECV smoked during pregnancy, fewer were morbidly obese, and fewer had a hypertensive disorder of pregnancy, compared to those who were eligible. Caesarean section occurred in 25.9% of successful compared to 95.6% of unsuccessful ECVs. Infant outcomes did not differ by ECV success.ConclusionsThe majority of women with a breech presentation did not receive ECV. It is unclear whether this is attributable to issues with service provision or low acceptability among women. Policies to improve access to and information about ECV appear necessary to improve uptake among women with term breech presentation. Improved data collection around the diagnosis of breech presentation, ECV attempts, and outcomes may help to identify specific barriers to ECV uptake.

External cephalic version at term: a cohort study of 18 years’ experience

“…Criteria for suitability for ECV are poorly established, and our exclusion criteria for ECV were less conservative than those used in other studies . In addition, ECV acceptance among the population of the study was high (89.8%) …”

Knowledge, attitude and practice of obstetricians towards external cephalic version

“…The same reasons were found in studies conducted in Australia and Korea. 17,18 26% opted to manage the situation by ECV the reasons for choosing this option were that apart from considering it safe they consider themselves expert in performing the procedure and managing the complication if it arises. A study done in Ireland which concluded the 10-year review on ECV also showed that it's a safe procedure and when performed by the operator who has performed 20 procedures the success rate of procedure is high.…”

Correlation of Obesity with External Cephalic Version Success among Women with One Previous Cesarean Delivery

“…In addition, there were more morbidly obese women in the group of eligible women who did not undergo ECV compared with the eligible women that underwent ECV. 35 Therefore, the obese women available in this analysis may have been motivated to receive an ECV and may have had multiple attempts at ECV, leading to a higher success rate. However, among the women who underwent an attempt, we do not expect a systematic difference in the way an ECV was performed for an obese patient with a prior cesarean delivery compared with a normal weight patient with a prior cesarean delivery.…”