(369) Obstetrical outcomes following External Cephalic Version (ECV)

External cephalic version (ECV) is a well-established obstetric procedure aimed at reducing the incidence of term breech presentation. Although considered safe and effective when performed according to guidelines, its impact on labor and immediate obstetrical outcomes remains debated. This study aimed to assess the association between labor following successful ECV and maternal and neonatal outcomes.

Study Design:

A retrospective cohort study was conducted, including all singleton term deliveries at a tertiary medical center between 1991 and 2021. Deliveries following a successful ECV were compared with deliveries without prior ECV. Maternal characteristics, obstetrical complications, and neonatal outcomes were analyzed. Multivariable logistic regression model was used to adjust for potential confounders.

Results:

Among 185,467 deliveries, 81 (0.04%) followed a successful ECV. Women delivering after ECV were more likely to be multiparous and to have gestational or pregestational diabetes (p=0.000). Labor following ECV was associated with higher rates of labor induction (38.2% vs. 21.2%, p=0.000) and umbilical cord prolapse (3.7% vs. 0.4%, p=0.000). Cesarean delivery (CD) rates were higher following ECV (11.1% vs. 5.0%, p=0.012), however, this association did not persist after adjusting for potential confounders such as labor induction, in a multivariable model (aOR 1.57, 95% CI 0.76–3.23, p=0.219). No significant differences were observed in major adverse obstetrical outcomes or neonatal outcomes, including umbilical cord pH < 7, fetal distress, low 5-minute Apgar score (< 7), meconium-stained amniotic fluid, or perinatal mortality.

Conclusion:

Successful ECV is not associated with an increased risk of severe adverse obstetrical or neonatal outcomes. Nevertheless, higher rates of umbilical cord prolapse warrant heightened vigilance during labor management following ECV.