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Mode of Delivery After Successful External Cephalic Version: A Systematic Review and Meta-analysis

de Hundt, Marcella MD; Velzel, Joost MD; de Groot, Christianne J. MD, PhD; Mol, Ben W. MD, PhD; Kok, Marjolein MD, PhD

doi: 10.1097/AOG.0000000000000295
Contents: Review

OBJECTIVE: To assess the mode of delivery in women after a successful external cephalic version by performing a systematic review and meta-analysis.

DATA SOURCES: We searched MEDLINE, Embase, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library for studies reporting on the mode of delivery in women after successful external cephalic version at term and women with a spontaneous cephalic-presenting fetus.

METHODS OF STUDY SELECTION: Two reviewers independently selected studies, extracted data, and assessed study quality. The association between mode of delivery and successful external cephalic version was expressed as a common odds ratio with a 95% confidence interval (CI).

TABULATION, INTEGRATION, AND RESULTS: We identified three cohort studies and eight case–control studies, reporting on 46,641 women. The average cesarean delivery rate for women with a successful external cephalic version was 21%. Women after successful external cephalic version were at increased risk for cesarean delivery for dystocia (odds ratio [OR] 2.2, 95% CI 1.6–3.0), cesarean delivery for fetal distress (OR 2.2, 95% CI 1.6–2.9), and instrumental vaginal delivery (OR 1.4, 95% CI 1.1–1.7).

CONCLUSION: Women who have had a successful external cephalic version for breech presentation are at increased risk for cesarean delivery and instrumental vaginal delivery as compared with women with a spontaneous cephalic presentation. Nevertheless, with a number needed to treat of three, external cephalic version still remains a very efficient procedure to prevent a cesarean delivery.

LEVEL OF EVIDENCE: (Data for <p> is not given in the PDF but is given in PDFs of other chapters, please confirm with PE)

Women after a successful external cephalic version are at increased risk for cesarean delivery compared with women with a spontaneous cephalic presentation

Departments of Obstetrics and Gynecology, VU Medical Center and Academic Medical Center, Amsterdam, The Netherlands; and the Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.

Corresponding author: Marcella De Hundt, MD, VU Medical Center, Department of Obstetrics and Gynecology, Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; e-mail: marcelladehundt@gmail.com.

The authors thank René Otten for designing the literature search strategy.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.