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Outcomes of breech presentation with or without external cephalic version in a large academic United States medical center
Abstract Number: SAT-02
Abstract Type: Original Research
Breech presentation occurs in 3-4% of term singleton pregnancies and external cephalic version (ECV) may reduce the cesarean delivery (CD) rate and complications associated with breech vaginal delivery (BVD).1 Despite a successful ECV (sECV), an urgent CD following ECV or at a later stage during labor may be required. The primary study aim was to evaluate the CD rate among women selecting ECV, and to compare outcomes with women who chose a term planned CD.
We identified all singleton pregnancies with a diagnosis of breech presentation that delivered >36wks (2010-2016) in a single U.S. academic center through a retrospective chart review. Breech cases were classified in groups based on obstetrical outcome; noECV/CD (planned CD without attempted ECV-CD at or before scheduled date), sECV/VD (sECV resulting in vertex vaginal delivery-VD), sECV/CD (sECV resulting in CD at term-intrapartum or secondary to breech), and fECV/CD (failed ECV resulting in CD-urgent or as planned). Use of neuraxial anesthesia was recorded.
Among 1006 eligible case-charts, 769 proceeded with CD (noECV/CD; 76.4%), 232 attempted ECV (23.1%) and 5 had a BVD (Figure). ECV was successful in 49 cases (sECV; 21.1%) of which 28 ultimately delivered vaginally (sECV/VD; 57.1%). Urgent CD hours following ECV occurred in 11 cases (4.7%), and placental abruption within 48h of ECV occurred in 5 cases (2.2%). Of remaining sECV, 16 had an intrapartum CD (32.7%), 3 of them urgently. Among the fECV/CD, 100 (54.6%) CDs were performed electively as scheduled and 64 were intrapartum. Neuraxial anesthesia was performed in 65/232 ECV (28.0%); ECV success rate with anesthesia was 35.4% and 15.5% without.
In our cohort of 1006 women covering 7 years of breech presentation, ECV was attempted in less than 25% of cases, and only 12.1% of all women with ECV successfully delivered vaginally. Although the ECV success rate was low, we confirm that neuraxial anesthesia increases the likelihood of success. These numbers suggest that ECV may not be particularly effective in reducing the overall CD rate, with more than 85% of women delivering via CD. Placental abruption and urgent CD occurred in a non-negligible number of cases.
Further comparisons of obstetrical and neonatal outcomes in women who deliver vaginally versus controls with spontaneous vertex presentations will be needed to further evaluate the risk;benefit ratio of ECV procedures.
1. Obstet Gynecol 2016:127(2):e54-61