Skip to main content
SMFM 2026 Pregnancy Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared outside of the session
Faculty have requested this content not be shared outside of the session
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
Poster Icons
Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 2

Category: Operative Obstetrics

Poster Session 2

(482) The safety and utility of attempting an external cephalic version after two prior cesarean deliveries

Wednesday, February 11, 2026
3:30 PM - 5:00 PM  

    Submitting Author and Presenting Author(s)

  • Emily Schlussel Markovic, MD

    MFM Fellow
    Maimonides Medical Center
    Brooklyn, New York, United States

    • Coauthor(s)

  • Itamar Futterman, MD

    Director, Complex Obstetrical Surgery, Maternal Fetal Medicine Attending
    Maimonides Medical Center
    Maimonides Health, New York, United States

  • Joselle O'Brien, MA, MD

    MFM Fellow
    Maimonides Medical Center
    Brooklyn, New York, United States

  • NF

    Nelli Fisher, MD

    Fellowship Program Director, Maternal Fetal Medicine Attending
    Maimonides Medical Center
    Brooklyn, New York, United States

  • Tirtza Spiegel Strauss, MD

    Fellow
    Maimonides Medical Center
    Brooklyn, New York, United States

  • Rodney A. McLaren, Jr, MD

    Maternal Fetal Medicine Attending
    Maimonides Medical Center
    Brooklyn, New York, United States

Objective:
ACOG considers patients with 2 prior cesarean deliveries (CD) to be candidates for a trial of labor (TOLAC) and separately recommends external cephalic version (ECV) be offered for malpresentation. However, little is known about the safety and utility of ECV among patients with 2 prior CD. This study aimed to evaluate obstetric outcomes after ECV in patients with 2 prior CD to better guide counseling.

Study Design:

A population study was performed utilizing the US Natality Database from 2018 to 2023 of non-anomalous, singleton births after 36 weeks gestation in those with 2 prior CD. Adverse maternal and neonatal composite outcomes were compared between those with an ECV attempt and those who had a breech repeat CD (rCD) without ECV attempt and TOLAC. Adverse maternal outcomes included blood transfusion, uterine rupture, unplanned hysterectomy, or ICU admission. Adverse neonatal outcomes included 5-min Apgar < 7, immediate or prolonged assisted ventilation, NICU admission, seizure, or death. ECV success rate and mode of delivery after ECV attempt were also assessed. Univariable and multivariable analyses were performed.

Results:

Of the 16,293 births that met inclusion criteria, 328 (2%) underwent ECV attempt. Of these ECVs, 223 (68%) were successful. Adverse maternal composite did not differ between births after ECV attempt and those without (1.8% vs. 1.5%, aOR 1.20, 95% CI 0.53-2.71). Those who had an ECV attempt had a lower risk of adverse neonatal composite compared to those who did not (9.5% vs. 18.2%, aOR 0.47, 95% CI 0.32-0.68). Of the 328 ECV attempts, 234 (71.3%) underwent rCD without TOLAC. Of 215 cephalic deliveries, those who had a rCD without TOLAC (n=146) had fewer prior vaginal births than those who had a TOLAC (n=69) (rCD: 1 (1,1) vs 2 (1,3), p< 0.001). Of the 94 patients with TOLAC, 52 (55.3%) had a spontaneous vaginal birth, 4 (4.3%) had an operative vaginal birth, and 38 (40.4%) had a rCD.

Conclusion:

These data suggest that an ECV in patients with 2 prior CD had a similar success rate to the general obstetric population and may be associated with decreased neonatal morbidity.