Pregnancy outcome after successful external cephalic version for breech presentation at term


      OBJECTIVE: Our purpose was to review the outcome of pregnancies after external cephalic version at term, in particular the incidence and indications of intrapartum cesarean section after successful external cephalic version. STUDY DESIGN: A prospective study was performed of 241 term pregnancies that had a total of 243 external cephalic versions. Each case with successful external cephalic version was matched to two control cases with cephalic presentation to compare pregnancy outcome. RESULTS: External cephalic version was successful in 169 attempts (69.5%), of which 7 (4.1%) reverted to breech presentation. There was one case of abruptio placentae and eight cases (3.3%) of transient fetal bradycardia after the procedure. Among those who had a successful external cephalic version, the incidence of intrapartum cesarean section was 16.9%, which was 2.25 times higher than that of the control group (p < 0.005). This large number of abdominal deliveries was due to a significantly higher incidence of fetal distress and dystocic labor. The incidence of augmentation of labor was also significantly higher in the study group (37.7% vs 27.6%, p < 0.05). CONCLUSION: Pregnancies after a successful external cephalic version at term are not the same as those with cephalic presentation. They are at higher risk of both dystocic labor and fetal distress and therefore require close intrapartum monitoring. (Am J Obstet Gynecol 1997;176:218-23.)


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        • Gifford DS
        • Morton SC
        • Fiske M
        • Kahn K
        A meta-analysis of infant outcomes after breech delivery.
        Obstet Gynecol. 1995; 85: 1047-1054
        • Miller Jr, JM
        Maternal and neonatal morbidity and mortality in cesarean section.
        Obstet Gynecol Clin North Am. 1988; 15: 629-638
        • Sachs BP
        • Yeh J
        • Acker D
        • Driscoll S
        • Brown DA
        Cesarean section–related maternal mortality in Massachusetts, 1954-1985.
        Obstet Gynecol. 1988; 71: 385-388
        • Zhang J
        • Bowes Jr, WA
        • Fortney JA
        Efficacy of external cephalic version: a review.
        Obstet Gynecol. 1993; 82: 306-312
        • Brocks V
        • Philipsen T
        • Secher NJ
        A randomized trial of external cephalic version with tocolysis in late pregnancy.
        Br J Obstet Gynaecol. 1984; 91: 653-656
        • Laros Jr, RK
        • Flanagan TA
        • Kilpatrick SJ
        Management of term breech presentation: a protocol of external cephalic version and selective trial of labor.
        Am J Obstet Gynecol. 1995; 172: 1916-1923
        • Dyson DC
        • Ferguson II, JE
        • Hensleigh P
        Antepartum external cephalic version under tocolysis.
        Obstet Gynecol. 1986; 67: 63-68
        • Gifford DS
        • Keeler E
        • Kahn KL
        Reductions in cost and cesarean rate by routine use of external cephalic version: a decision analysis.
        Obstet Gynecol. 1995; 85: 930-936
        • VanDorsten JP
        • Schifrin BS
        • Wallace RL
        Randomized control trial of external cephalic version with tocolysis in late pregnancy.
        Am J Obstet Gynecol. 1981; 141: 417-424
        • Egge T
        • Schauberger C
        • Schaper A
        Dysfunctional labor after external cephalic version.
        Obstet Gynecol. 1994; 83: 771-773
        • Hanss Jr, JW
        The efficacy of external cephalic version and its impact on the breech experience.
        Am J Obstet Gynecol. 1990; 162: 1459-1463
        • Shalev E
        • Battino S
        • Giladi Y
        • Edelstein S
        External cephalic version at term—using tocolysis.
        Acta Obstet Gynecol Scand. 1993; 72: 455-457
        • Marchick R
        Antepartum external cephalic version with tocolysis: a study of term singleton breech presentations.
        Am J Obstet Gynecol. 1988; 158: 1339-1346
        • Stine LE
        • Phelan JP
        • Wallace R
        • Eglinton GS
        • van Dorsten JP
        Update on external cephalic version performed at term.
        Obstet Gynecol. 1985; 65: 642-646
        • Cook HA
        Experience with external cephalic version and selective vaginal breech delivery in private practice.
        Am J Obstet Gynecol. 1993; 168: 1886-1889
        • Stock A
        • Chung T
        • Rogers M
        • Wong WM
        Randomized, double blind, placebo controlled comparison of ritodrine and hexoprenaline for tocolysis prior to external cephalic version at term.
        Aust N Z J Obstet Gynaecol. 1993; 33: 265-268
        • Lau TK
        • Stock A
        • Rogers M
        Fetomaternal haemorrhage after external cephalic version at term.
        Aust N Z J Obstet Gynaecol. 1995; 35: 173-174
        • Keegan Jr, KA
        • Paul RH
        Antepartum fetal heart rate testing: the nonstress test as a primary approach.
        Am J Obstet Gynecol. 1980; 136: 75-80
        • Hellstrom AC
        • Nilsson B
        • Stange L
        • Nylund L
        When does external cephalic version succeed?.
        Acta Obstet Gynecol Scand. 1990; 69: 281-285
        • Hofmeyr GJ
        • Sadan O
        • Myer IG
        • Galal KC
        • Simko G
        External cephalic version and spontaneous version rates: ethnic and other determinants.
        Br J Obstet Gynaecol. 1986; 93: 13-16
        • Wallace RL
        • VanDorsten JP
        • Eglinton GS
        • Meuller E
        • McCart D
        • Schifrin BS
        External cephalic version with tocolysis: observations and continuing experience at the Los Angeles Country/University of Southern California Medical Center.
        J Reprod Med. 1984; 29: 745-748
        • Thunedlorg P
        • Fischer-Rasmussen W
        • Tollund L
        The benefit of external cephalic version with tocolysis as a routine procedure in late pregnancy.
        Eur J Obstet Gynecol Reprod Biol. 1991; 42: 23-27
        • Schachter M
        • Kogan S
        • Blickstein I
        External cephalic version after previous cesarean section—a clinical dilemma.
        Int J Gynaecol Obstet. 1994; 45: 17-20
        • Flamm BL
        • Fried MW
        • Lonky NM
        • Giles WS
        External cephalic version after previous cesarean section.
        Am J Obstet Gynecol. 1991; 165: 370-372