External cephalic version safe and effective option for women with previous cesarean section, reveals research

Non-cephalic presentations are observed in 3% of pregnancies at term. Affected pregnant women may be presented with the choices of an elective cesarean section (CS), a vaginal breech delivery, or an external cephalic version (ECV). Recent research paper thoroughly investigates the success rate and complications associated with external cephalic version (ECV) in pregnant women who have previously undergone a cesarean section. Conducted as a retrospective cohort study at the “Virgen de la Arrixaca” Clinic University Hospital in Murcia, Spain, the study analyzed data from January 2014 to December 2023, including 911 women who were offered ECV, with 42 of them having a history of cesarean delivery.

Success Rates and Complications

The success rate of ECV in the group with prior cesarean sections was found to be 78.6%, with no significant difference compared to the 72.3% success rate in women without a previous cesarean (P = 0.371). The study calculated an adjusted odds ratio (aOR) of 1.18 for women with a previous cesarean, indicating no significant disadvantage when compared to those without. Additionally, the study highlights that multiparity, amniotic fluid volume, and transverse fetal lie were significant factors positively correlated with ECV success rates. The overall complication rate for ECV was relatively low at 9.5% among women with prior cesarean deliveries, with complications including non-reassuring fetal heart rates (7.1%) and major vaginal bleeding (2.4%). The findings reinforce the safety of ECV procedures even for women who have experienced a cesarean section. It emphasizes that the presence of a uterine scar should not deter healthcare providers from offering ECV to eligible patients with breech presentations at term. The complications related to ECV were comparable between those with and without previous cesarean sections, suggesting ECV is a viable option for women seeking vaginal delivery.

Limitations and Future Directions

The authors note that while the results are promising, limitations include the small sample size of women with prior cesarean sections and the retrospective nature of the study. The paper calls for more prospective studies to further validate these findings and establish protocols surrounding ECV in women with prior cesarean deliveries. Overall, this study contributes significant evidence supporting ECV as a safe practice for women with previous cesarean histories, aiding in the decision-making process for those desiring a vaginal birth after cesarean.

Key Points

- The study is a retrospective cohort analysis conducted at a Spanish hospital, examining the outcomes of external cephalic version (ECV) in 911 pregnant women, of whom 42 had previously undergone cesarean sections, over a period from January 2014 to December 2023.

- The success rate of ECV for the women with prior cesarean deliveries was 78.6%, comparable to the 72.3% success rate in those without a cesarean history, indicating that a previous cesarean does not significantly hinder ECV efficacy (P = 0.371).

- An adjusted odds ratio (aOR) of 1.18 was calculated for the ECV success among women with prior cesarean sections, further underscoring that these women do not face significant disadvantages compared to those who have not had a cesarean.

- Key factors influencing positive ECV outcomes included multiparity, amniotic fluid volume, and transverse fetal lie, all contributing to higher success rates in the procedure.

- The overall complication rate associated with ECV in women with prior cesarean was low at 9.5%, with reported complications including non-reassuring fetal heart rates (7.1%) and major vaginal bleeding (2.4%).

- Despite the positive findings, the study acknowledges limitations such as a small sample size of women with prior cesareans and its retrospective design, advocating for further prospective research to validate results and enhance clinical guidelines for ECV in this demographic.

Reference –

J. SáNchez-Romero et al. (2024). External Cephalic Version Following Prior Cesarean Delivery: A Comparative Cohort Analysis.. *International Journal Of Gynaecology And Obstetrics: The Official Organ Of The International Federation Of Gynaecology And Obstetrics*. https://doi.org/10.1002/ijgo.15738