(358) Feasibility and Outcomes of External Cephalic Version among SGA births

The American College of Obstetricians and Gynecologists recommend that external cephalic version (ECV) should be offered to patients with breech presentation. The objective of our study was to evaluate the efficacy and perinatal outcomes among births with SGA infants after an ECV.

Study Design:

This was a population based, cross sectional study using National Vitality Statistics data of singleton, non-anomalous, neonates born after 36 weeks of gestation, with birthweight of < 2500g between 2021 and 2023. Births with a maternal history of previous cesarean delivery (CD) were excluded. Births were divided into those who had an ECV attempt and those who had a breech CD without a trial of labor. Adverse maternal outcomes (blood transfusion, ICU admission, unplanned hysterectomy) and neonatal outcomes (assisted ventilation use, NICU admission, seizures, surfactant use, death) were compared between groups using univariable and multivariable analysis.

Results:

A total of 8021 births met inclusion criteria. Of the 8021 births, 812 (10.1%) had an ECV attempt and 7209 (89.8%) had a breech CD without a trial of labor. There were clinically significant differences in baseline characteristics between groups (Table 1). Among those who had an ECV attempt, 338 (41.6%) had a successful ECV, of which 233 (68.9%) subsequently delivered vaginally. After adjusting for clinical differences, births that had an ECV attempt had lower odds of neonatal assisted ventilation use (aOR 0.65, 95% CI 0.46- 0.92) and NICU admission (aOR 0.48, 95% CI 0.40-0.58) than those who had a CD without a trial of labor. There were no significant differences in maternal outcomes between the two groups (Table 2).

Conclusion:

Although ECV was successful in only 41.6% of births with SGA infants, there were lower rates of assisted ventilation use and NICU admission among those who had an ECV attempt.