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Peripartum maternal outcomes of term breech presentation delivery: impact of successful external cephalic version
Abstract Number: O1-04
Abstract Type: Original Research
Objective: External cephalic version (ECV) allows for vaginal delivery of a previously breech presentation fetus;(1) however, the maternal outcomes and costs associated with breech presentation delivery and successful ECV are largely unreported. We report these outcomes in a large, nationwide sample of delivery admissions.
Methods: Term deliveries were sourced following either successful ECV or persistent breech presentation, using ICD-9 codes and the Nationwide Inpatient Sample (20% of US inpatient hospital admissions); we excluded contraindications to ECV. Temporal trends were evaluated for the proportion of breech deliveries undergoing successful ECV. Logistic regression analysis determined predictors for successful ECV among breech deliveries. Maternal outcomes following successful ECV were compared to those with persistent breech adjusting for potential confounders.
Results: From 1998-2011, we identified 1,079,576 women with breech presentation; 56,409 (5.2%) underwent successful ECV. The cesarean delivery (CD) rate was 20.2% following successful ECV vs. 94.9% for persistent breech presentation. The proportion of successful ECV declined over the 14-year period (Figure). Successful ECV is associated with significant reductions in maternal sepsis (adjusted odds ratio (aOR) 0.35, 95% confidence interval (CI) 0.24-0.51) and non-significant reductions in pulmonary embolism, transfusion, hysterectomy, and anesthetic complications. Successful ECV was associated with reduced hospital charges, 2,271 USD, 95% CI 2,553-1,989 and maternal hospital stay, 0.67 days, 95% CI 0.73-0.60. The hospital CD rate (all deliveries, not just breech presentation) was the most significant predictor of successful ECV: Adjusting for other characteristics (reference was CD rate < 20%), the aOR of successful ECV was 0.75 (95% CI 0.62-0.90) for CD rate of 20-24%, 0.60 (95% CI 0.49-0.73) for 25-29%, 0.48 (95% CI 0.37-0.64) for 30-34%, and 0.35 (95% CI 0.29-0.43) for ≥35%.
Conclusion: In our nationwide US sample, ECV utilization was low. Successful ECV is performed less frequently at centers with high CD rates. Delivery following successful ECV is associated with reductions in CD rates, costs, and maternal morbidity. Efforts to increase the practice of ECV, including use of neuraxial analgesia and anesthesia (2), should be supported.
References: (1) ACOG Committee Opinion No. 340. Obstet Gynecol. 2006;108:235-7. (2) Sultan P et al. Int J Obstet Anesth 2011, 20:299–306.