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Association Between Attempted External Cephalic Version and Perinatal Morbidity and Mortality

Son, Moeun, MD, MSCI; Roy, Archana, MD; Grobman, William A., MD, MBA; Miller, Emily S., MD, MPH

doi: 10.1097/AOG.0000000000002699
Contents: Obstetric Complications: Original Research

OBJECTIVE: To examine whether, with fetal malpresentation at term, perinatal morbidity and mortality differ between women who undergo an external cephalic version (ECV) attempt and those who do not and are expectantly managed.

METHODS: We conducted a retrospective cohort study of women with nonanomalous singleton gestations in nonvertex presentation delivering at a tertiary care institution from 2006 to 2016. Women undergoing an ECV attempt at 37 weeks of gestation or greater were compared with those with nonvertex fetuses who did not undergo an ECV attempt and delivered at 37 weeks of gestation or greater. The primary outcome was a composite of perinatal morbidity and mortality including stillbirth, neonatal death within 72 hours, Apgar score less than 5 at 5 minutes, umbilical artery pH less than 7.0, base deficit 12 mmol/L or greater, or neonatal therapeutic hypothermia. Secondary outcomes were neonatal intensive care unit admission and neonatal anemia (hemoglobin value less than 13.5 g/dL). Bivariable and multivariable analyses were performed.

RESULTS: Of the 4,117 women meeting eligibility criteria, 1,263 (30.7%) attempted ECV; 509 (40.3%) of these attempts resulted in successful versions. In bivariable analyses, women who underwent attempted ECV were more likely to be non-Hispanic white and multiparous and had lower mean body mass indexes. The composite perinatal morbidity and mortality outcome did not differ significantly between women who did and did not undergo attempted ECV (2.9% vs 2.5%, P=.46). The frequencies of neonatal intensive care unit admission (3.6% vs 3.3%, P=.53) and neonatal anemia (1.6% vs 1.2%, P=.36) were also similar. There continued to be no association between ECV attempt and composite perinatal morbidity and mortality outcome after adjustment for potential confounders (adjusted odds ratio 1.02, 95% CI 0.66–1.60).

CONCLUSION: Compared with expectant management, an ECV attempt at term is not associated with increased perinatal morbidity or mortality.

An external cephalic version attempt at term is not associated with increased perinatal morbidity or mortality when compared with expectant management of fetal malpresentation.

Division of Maternal-Fetal Medicine and the Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Corresponding author: Moeun Son, MD, MSCI, 250 E Superior Street, Suite 05-2175, Chicago, IL 60611; email:

Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422, and by the Eunice Kennedy Shriver National Institute of Child and Human Development K12 HD050121-09 (E.S.M.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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

Presented at the 37th Annual Meeting of the Society for Maternal-Fetal Medicine, January 23–28, 2017, Las Vegas, Nevada.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received February 23, 2018

Received in revised form April 13, 2018

Accepted May 2, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.