Cesarean Delivery Rates After External Version [23A]

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External Cephalic version from breech presentation can reduce the incidence of cesarean delivery though it is unknown by how much. The objective of this study was to examine the magnitude of a successful external version on cesarean delivery rates in US births.


Retrospective cohort analysis of the 2012–2013 CDC birth certificate data for term (37 weeks and over) singleton pregnancies without a prior cesarean delivery and birthweights over 2,499 grams. We included the 40 US states covering approximately 90 percent of all births which have recently started to include information on successful and unsuccessful version attempts on their birth certificates.


There were a total of 5,026,737 pregnancies in this study, 2,337,541 were nulliparous, 2,689,196 were multiparous. 57% (8,252/14,469) of external versions were successful. The cesarean delivery rate was significantly lower after a successful version (16.2% after successful version vs 89.8%%; RR 0.18; 95% CI 0.17–0.19, P<.0001), more in multiparous patients (10.6% vs 85.7%; RR 0.12; 95% CI 0.11–0.13, P<.0001) than nulliparous patients (26.2% vs 93.2%; RR 0.28; 95% CI 0.27–0.30, P<.0001).


An external version can be successful in over 50% of attempts. After successful version cesarean delivery rates can be reduced by over 80%. These data should be shared with all patient with breech presentation at term. External version should be offered to all patients with breech presentation at term to reduce cesarean delivery rates.

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