What Happens after a Failed External Cephalic Version? [36I]

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Abstract

INTRODUCTION:

To compare perinatal outcomes following a failed external cephalic version (ECV) to a successful ECV and a planned cesarean delivery

METHODS:

This was a retrospective cohort study from January 2012 to June 2015. We included singleton, nonanamolous live births delivered after 36 weeks. We performed a comparison of perinatal outcomes between women who had an unsuccessful ECV, a successful ECV and a planned cesarean delivery. The primary outcome was a composite of neonatal outcomes, which included APGAR <7 at 5 minutes, NICU or intermediate care nursery admission, need for respiratory support and hypoglycemia. A secondary outcome was final mode of delivery among women attempting ECV.

RESULTS:

We identified 236 pregnancies meeting inclusion criteria, 126 (53.3%) of which attempted ECV with 110 (46.7%) undergoing planned cesarean delivery. The success rate of external cephalic version (ECV) was 50.7% (n=64). Among women who had successful ECV, the rate of cesarean section was 25% (n=16). Among women with failed ECV, the rate of the primary outcome was 6.8% (n=4), versus 12.9% (n=7) in the successful group and 10.9% (n=12) in the planned cesarean group (p=0.59). There was no difference in the rates of Apgar score <7 at 5 minutes, NICU or intermediate care nursery admission, need for respiratory support or hypoglycemia.

CONCLUSION:

ECV was not associated with an absolute risk increase in the primary composite outcome compared to planned cesarean for fetal malpresentation. This evidence provides support for ECV as a safe alternative for women with fetal malpresentation who desire a vaginal delivery regardless of outcome.

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