Poster Session 2
Category: Obstetric Quality and Safety
Poster Session 2
Michal Axelrod, MD, MPH (she/her/hers)
Sheba Medical Center
Sheba Medical Center, HaMerkaz, Israel
Shlomi Toussia-Cohen, MD (he/him/his)
The Sheba Medical Center
The Sheba Medical Center, HaMerkaz, Israel
Tal Cahan, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Ronit Silber, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Shir Koren
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Maayan Mandelbaum
Faculty of Medicine, Tel Aviv University, Israel
Tel Aviv, HaMerkaz, Israel
Chen Berkovitz
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Orit Moran
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
To assess the safety and success rate of external cephalic version (ECV) in pregnancies with suspected small-for-gestational-age (SGA) fetuses, including those with fetal growth restriction (FGR), defined as estimated fetal weight (EFW) ≤ the 3rd percentile.
Study Design:
A retrospective cohort study was conducted at a large tertiary center between 2011–2024. Singleton pregnancies undergoing ECV with an EFW assessed within two weeks prior to the procedure, based on Hadlock 4 curves, were included. Patients were categorized into SGA (< 10th percentile) and appropriate-for-gestational-age (AGA) groups, large-for-gestational-age (LGA) were excluded. Baseline characteristics, ECV success, complications, and perinatal outcomes were compared.
Results:
Of 1152 women, 195 (16.9%) were classified as SGA, including 31 (2.7%) with FGR. The AGA group included 957 women (83.1%). Baseline characteristics were generally comparable, except for lower BMI in the SGA group (25.8 vs. 27.5, p< 0.001). There was a trend toward higher rates of polyhydramnios in AGA cases (p=0.069). ECV success rates were similar between SGA and AGA (54.4% vs. 56.8%, p=0.524), and slightly lower among FGR cases (45.2%). Complications were rare and limited to isolated episodes of variable fetal heart rate decelerations, observed more frequently in SGA (2.1% vs. 0.6%, p=0.072), including one event (3.2%) in the FGR subgroup. Spontaneous reversion to breech following successful ECV occurred at similar rates across groups (2.6% vs. 3.1%, p=0.715). Mode of delivery did not differ significantly. Postnatal birth weights confirmed that not all prenatally suspected to be SGA were truly growth restricted (60.5%).
Conclusion:
ECV appears safe and effective in pregnancies with suspected SGA, including those with EFW below the 3rd percentile. These findings support the inclusion of select growth-restricted fetuses in ECV candidates and underscore the limitations of prenatal SGA classification.