Successful vaginal delivery after external cephalic version (ECV): does time interval from ECV to delivery make a difference? A multicenter study

Purpose: The risk of cesarean delivery after a successful external cephalic version for breech presentation is higher as compared with fetuses in cephalic presentation. However, the role of the time interval between version attempt to delivery on the risk for cesarean delivery is unclear. We aimed to study the effect of the time interval from a successful external cephalic version to delivery on the risk for cesarean delivery and assess factors associated with cesarean delivery after a successful version.

Methods: We conducted a multicenter, retrospective cohort study, including all successful external cephalic version at two medical centers between 2011 and 2019. We compared patient baseline characteristics, obstetric characteristics, maternal and neonatal outcomes in women that delivered by vaginal delivery with those who delivered by cesarean delivery.

Results: Overall, 769 deliveries were included. Of these, 98 women (12.7%) had cesarean delivery and 671 (87.3%) had vaginal delivery. Women who had cesarean delivery had a higher rate of obesity (44.9% vs 21.9%, p < 0.001; OR 2.88, CI 1.65-5.03) and nulliparity (45.9% vs 24.5%, p < 0.001; OR = 2.58, CI 1.67-3.98). The risk for intrapartum cesarean delivery did not differ according to time interval from external cephalic version to delivery.

Conclusions: The time interval between successful external cephalic version and delivery was not associated with mode of delivery. This finding is in contrast to previous reports. The risk for cesarean delivery after successful version is higher in nulliparous, obese women, and women whose weight gain in pregnancy was higher.

Keywords: Breech presentation; Cesarean delivery; External cephalic version; Mode of delivery; Nulliparity.