Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2018; 08(04): e349-e354
DOI: 10.1055/s-0038-1676297
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery

Rodney A. McLaren Jr.
1   Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Fouad Atallah
1   Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Nelli Fisher
1   Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Howard Minkoff
1   Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
› Author Affiliations
Further Information

Publication History

04 September 2018

16 October 2018

Publication Date:
28 November 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD.

Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes.

Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% (p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17–5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19–21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10–2.82]).

Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.

Keywords

blood transfusion - cesarean delivery - external cephalic version - trial of labor after cesarean - unplanned hysterectomy
 

  • References

  • 1 Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2015; ;( (04) CD000083
    PubMedSearch in Google Scholar
  • 2 Hartnack Tharin JE, Rasmussen S, Krebs L. Consequences of the term breech trial in Denmark. Acta Obstet Gynecol Scand 2011; 90 (07) 767-771
    CrossrefPubMedSearch in Google Scholar
  • 3 . American College of Obstetricians and Gynecologists' Committee on Practice Bulletins--Obstetrics. Practice bulletin no. 161: external cephalic version. Obstet Gynecol 2016; 127 (02) e54-e61
    CrossrefPubMedSearch in Google Scholar
  • 4 Grootscholten K, Kok M, Oei SG, Mol BW, van der Post JA. External cephalic version-related risks: a meta-analysis. Obstet Gynecol 2008; 112 (05) 1143-1151
    CrossrefPubMedSearch in Google Scholar
  • 5 Flamm BL, Fried MW, Lonky NM, Giles WS. External cephalic version after previous cesarean section. Am J Obstet Gynecol 1991; 165 (02) 370-372
    CrossrefPubMedSearch in Google Scholar
  • 6 Schachter M, Kogan S, Blickstein I. External cephalic version after previous cesarean section--a clinical dilemma. Int J Gynaecol Obstet 1994; 45 (01) 17-20
    CrossrefPubMedSearch in Google Scholar
  • 7 de Meeus JB, Ellia F, Magnin G. External cephalic version after previous cesarean section: a series of 38 cases. Eur J Obstet Gynecol Reprod Biol 1998; 81 (01) 65-68
    CrossrefPubMedSearch in Google Scholar
  • 8 Abenhaim HA, Varin J, Boucher M. External cephalic version among women with a previous cesarean delivery: report on 36 cases and review of the literature. J Perinat Med 2009; 37 (02) 156-160
    CrossrefPubMedSearch in Google Scholar
  • 9 Weill Y, Pollack RN. The efficacy and safety of external cephalic version after a previous caesarean delivery. Aust N Z J Obstet Gynaecol 2017; 57 (03) 323-326
    CrossrefPubMedSearch in Google Scholar
  • 10 Sela HY, Fiegenberg T, Ben-Meir A, Elchalal U, Ezra Y. Safety and efficacy of external cephalic version for women with a previous cesarean delivery. Eur J Obstet Gynecol Reprod Biol 2009; 142 (02) 111-114
    CrossrefPubMedSearch in Google Scholar
  • 11 Regalia AL, Curiel P, Natale N. , et al. Routine use of external cephalic version in three hospitals. Birth 2000; 27 (01) 19-24
    CrossrefPubMedSearch in Google Scholar
  • 12 Keepanasseril A, Anand K, Soundara Raghavan S. Matched cohort study of external cephalic version in women with previous cesarean delivery. Int J Gynaecol Obstet 2017; 138 (01) 79-83
    CrossrefPubMedSearch in Google Scholar
  • 13 Landon MB, Hauth JC, Leveno KJ. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351 (25) 2581-2589
    CrossrefPubMedSearch in Google Scholar
  • 14 Lappen JR, Hackney DN, Bailit JL. Outcomes of term induction in trial of labor after cesarean delivery: analysis of a modern obstetric cohort. Obstet Gynecol 2015; 126 (01) 115-123
    CrossrefPubMedSearch in Google Scholar
  • 15 Rijnders M, Offerhaus P, van Dommelen P, Wiegers T, Buitendijk S. Prevalence, outcome, and women's experiences of external cephalic version in a low-risk population. Birth 2010; 37 (02) 124-133
    CrossrefPubMedSearch in Google Scholar
  • 16 Caukwell S, Joels LA, Kyle PM, Mills MS. Women's attitudes towards management of breech presentation at term. J Obstet Gynaecol 2002; 22 (05) 486-488
    CrossrefPubMedSearch in Google Scholar
  • 17 Friedman AM, Wright JD, Ananth CV, Siddiq Z, D'Alton ME, Bateman BT. Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations. Am J Obstet Gynecol 2016; 215 (05) 640.e1-640.e8
    CrossrefPubMedSearch in Google Scholar