Effectiveness and Safety of External Cephalic Version in Full-Term Breech Presentations: Retrospective Study

Qianqian He,1,* Fuchun Cui,2,* Yanling Jin,1 Haiying Li,1 Xiaofen Duan,1 Yanlei Xu,1,* Qian Wang1,* 1Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, People’s Republic of China; 2Department of Anesthesiology, Hebei Maternity Hospital, Shijiazhuang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qian Wang, Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, People’s Republic of China, Email wangqiansy@outlook.com Yanlei Xu, Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, People’s Republic of China, Email xuyanleisy@outlook.comBackground: External cephalic version (ECV) is a pivotal intervention aimed at converting abnormal foetal presentations to cephalic in full-term pregnancies, thereby reducing cesarean delivery rates. This study evaluated the effectiveness of ECV and examined factors influencing its success.Methods: We conducted single-centre retrospective observational study at the Fourth Hospital of Shijiazhuang, high-volume tertiary obstetric centre, from January 2018 to December 2023. Three hundred and sixty-five women with singleton-term pregnancies and breech, transverse, or oblique foetal presentation who underwent attempted ECV were included. Detailed clinical data, encompassing maternal characteristics, procedural variables, and delivery outcomes, were extracted from medical records. ECV success was defined as conversion to cephalic presentation confirmed by ultrasound without associated complications. Statistical analyses, including univariate and multivariate logistic regression, were performed to identify independent predictors of successful ECV.Results: Among the study population, 237 patients achieved successful ECV, representing a 64.9% success rate. No major maternal or neonatal complications attributable to the ECV procedure were documented in the study cohort. Multivariate analysis revealed that management by specialized disease team (adjusted OR: 3.262, p< 0.001) and multiparity (adjusted OR: 2.374, p=0.001) were significantly associated with higher success rates. Conversely, an anterior placental location significantly reduced the odds of successful ECV (adjusted OR: 0.495, p=0.004). Maternal age and gestational age at the time of the procedure were not significant predictors.Conclusion: Our findings underscore that specialized team management and favourable obstetric history are critical determinants of successful ECV, whereas an anterior placental location poses a significant impediment. These insights can inform clinical protocols and guide future research aimed at optimizing ECV outcomes.Keywords: breech presentation, external cephalic version, placenta, pregnancy