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External Cephalic Version–Related Risks: A Meta-analysis

Grootscholten, Kim MSc1; Kok, Marjolein MD1; Oei, S Guid MD, PhD2; Mol, Ben W. J. MD, PhD1; van der Post, Joris A. MD, PhD1

doi: 10.1097/AOG.0b013e31818b4ade

OBJECTIVE: To systematically review the literature on external cephalic version–related complications and to assess if the outcome of a version attempt is related to complications.

DATA SOURCES: In March 2007 we searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.

METHODS OF STUDY SELECTION: Studies reporting on complications from an external cephalic version attempt for singleton breech pregnancies after 36 weeks of pregnancy were selected. We calculated odds ratios (ORs) from studies that reported both on complications as well as on the position of the fetus immediately after the procedure.

TABULATION, INTEGRATION, AND RESULTS: We found 84 studies, reporting on 12,955 version attempts that reported on external cephalic version–related complications. The pooled complication rate was 6.1% (95% CI 4.7–7.8), 0.24% for serious complications (95% confidence interval [CI] 0.17–0.34) and 0.35% for emergency cesarean deliveries (95% CI 0.26–0.47). Complications were not related to external cephalic version outcome (OR 1.2 (95% CI 0.93–1.7).

CONCLUSION: External cephalic version is a safe procedure. Complications are not related to the fetal position after external cephalic version.

External cephalic version is a safe procedure, and complications are not related to the outcome of the procedure.

From the Departments of Obstetrics and Gynecology, 1Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; and 2Máxima Medical Centre, Veldhoven, the Netherlands.

Corresponding author: Marjolein Kok, MD, Academic Medical Centre, Department of Obstetrics & Gynecology, Meibergdreef 9, room H4-205, Amsterdam, 1105AZ, the Netherlands; e-mail:

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists