Skip to main content

Advertisement

SpringerLink
Log in

Predictors for a successful external cephalic version: a single centre experience

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The external cephalic version (ECV) is one of the options patients presenting with a breech pregnancy should be offered. Various fetal, maternal and other predictors for a successful ECV have been published in the past.

Methods

This is a retrospective multivariate analysis of our ECV patient database at the Department of Obstetrics and Gynaecology at the University Hospital Ulm. In an outpatient setting, patients with fetal breech position were routinely offered an ECV attempt after 36 weeks of gestation if the patient was willing to consent. Contraindications for ECV were placental abruption, placenta praevia, uterus malformations, regular contractions, premature rupture of membranes, and non-reassuring fetal heart rate patterns.

Results

From January 1st 2010 to July 31st 2013, 444 patients with a minimum of 36 weeks gestational age (i.e. >35 + 6 weeks) attended our clinic with a breech presentation. Of those 118 had an ECV attempt and an extended ultrasound examination within 21 days. In 33 patients the procedure was successful (success rate 28 %). A multivariate binary logistic regression analysis revealed that an increased Amniotic Fluid Index (AFI; p < 0.001), at least one prior vaginal delivery (p = 0.002) or a high estimated fetal weight (p = 0.045) were significant independent predictors for a successful ECV. In our series no delivery occurred within 48 h after the ECV.

Conclusions

An ECV is a safe procedure. ECV should be offered as an option for the mother-to-be on the basis of an informed consent. Identified fetal and maternal factors can help to estimate the chances of success and in particular multi-parity and increased amniotic fluid seem to be associated with successful ECV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hofmeyr GJ, Hannah ME (2003) Planned caesarean section for term breech delivery. Cochrane database Syst Rev 3:CD000166

    PubMed  Google Scholar 

  2. Hofmeyr GJ, Kulier R (2012) External cephalic version for breech presentation at term (Review). Cochrane Database Syst Rev 10(10):CD000051

    PubMed  Google Scholar 

  3. RCOG (2006) External cephalic version (Green Top 20a). RCOG green top guidelines. RCOG, London [cited 2014 Jul 2]

  4. American College of Obstetricians and Gynecologists (2014) External cephalic version. ACOG practice bulletin Number 13, Feb 2000. Reaffirmed. (http://www.acog.org/-/media/List-of-Titles/PBListOfTitles.pdf)

  5. Newman RB, Peacock BS, Van Dorsten JP, Hunt HH (1993) Predicting success of external cephalic version. Am J Obstet Gynecol 169(2 Pt 1):245–249 (discussion 249–250)

  6. Phelan JP, Ahn MO, Smith CV, Rutherford SE, Anderson E (1987) Amniotic fluid index measurements during pregnancy. J Reprod Med 32(8):601–604

    CAS  PubMed  Google Scholar 

  7. Rutherford SE, Phelan JP, Smith CV, Jacobs N (1987) The four-quadrant assessment of amniotic fluid volume: an adjunct to antepartum fetal heart rate testing. Obstet Gynecol 70(31):353–356

    CAS  PubMed  Google Scholar 

  8. Ciliacus E, van der Zalm M, Truijens SE, Hasaart TH, Pop VJ, Kuppens SM (2014) Fear for external cephalic version and depression: predictors of successful external cephalic version for breech presentation at term? BMC Pregnancy Childbirth 14:101

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bogner G, Hammer BE, Schausberger C, Fischer T, Reisenberger K, Jacobs V (2014) Patient satisfaction with childbirth after external cephalic version. Arch Gynecol Obstet 289(3):523–531

    Article  PubMed  Google Scholar 

  10. Chan LY-S, Leung TY, Fok WY, Chan LW, Lau TK (2004) Prediction of successful vaginal delivery in women undergoing external cephalic version at term for breech presentation. Eur J Obstet Gynecol Reprod Biol 116(1):39–42

    Article  PubMed  Google Scholar 

  11. Kok M, Cnossen J, Gravendeel L, Van Der Post JA, Mol BW (2009) Ultrasound factors to predict the outcome of external cephalic version: a meta-analysis. Ultrasound Obstet Gynecol 33(1):76–84

    Article  CAS  PubMed  Google Scholar 

  12. Cluver C, Hofmeyr GJ, Gyte GM, Sinclair M (2012) Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane database Syst Rev 1:CD000184

    PubMed  PubMed Central  Google Scholar 

  13. Vas J, Aranda-Regules JM, Modesto M, Ramos-Monserrat M, Barón M, Aguilar I et al (2013) Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial. Acupunct Med 31(1):31–38

    Article  PubMed  Google Scholar 

  14. Say R, Thomson R, Robson S, Exley C (2013) A qualitative interview study exploring pregnant women’s and health professionals’ attitudes to external cephalic version. BMC Pregnancy Childbirth 13:4

    Article  PubMed  PubMed Central  Google Scholar 

  15. Minkoff H, Ecker J (2013) A reconsideration of home birth in the United States. J Clin Ethics 24(3):207–214

    PubMed  Google Scholar 

  16. Ecker J, Minkoff H (2011) Home birth: what are physicians’ ethical obligations when patient choices may carry increased risk? Obstet Gynecol 117(5):1179–1182

    Article  PubMed  Google Scholar 

  17. Vlemmix F, Kuitert M, Bais J, Opmeer B, van der Post J, Mol BW et al (2013) Patient’s willingness to opt for external cephalic version. J Psychosom Obstet Gynaecol 34(1):15–21

    Article  PubMed  Google Scholar 

  18. De Meeus JB, Ellia F, Magnin G (1998) External cephalic version after previous cesarean section: a series of 38 cases. Eur J Obstet Gynecol Reprod Biol 81(1):65–68

    Article  PubMed  Google Scholar 

  19. Sela HY, Fiegenberg T, Ben-Meir A, Elchalal U, Ezra Y (2009) Safety and efficacy of external cephalic version for women with a previous cesarean delivery. Eur J Obstet Gynecol Reprod Biol 142(2):111–114

    Article  PubMed  Google Scholar 

  20. Burgos J, Cobos P, Rodríguez L, Osuna C, Centeno MM, Martínez-Astorquiza T et al (2014) Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. BJOG 121(2):230–235 (discussion 235). doi:10.1111/1471-0528.12487

  21. Lowe PJ, Mamers PM, Sturrock TV, Healy D (1998) A casemix cost comparison of 2 treatments for ectopic pregnancy. Aust N Z J Obstet Gynaecol 38(3):333–335

    Article  CAS  PubMed  Google Scholar 

  22. Tasnim N, Mahmud G, Khurshid M (2009) External cephalic version with salbutamol success rate and predictors of success. J Coll Physicians Surg Pak 19(2):91–94

    PubMed  Google Scholar 

  23. Ben-Meir A, Erez Y, Sela HY, Shveiky D, Tsafrir A, Ezra Y (2008) Prognostic parameters for successful external cephalic version. J Matern Fetal Neonatal Med 21(9):660–662

    Article  PubMed  Google Scholar 

  24. Kok M, van der Steeg JW, van der Post JAM, Mol BWJ (2011) Prediction of success of external cephalic version after 36 weeks. Am J Perinatol 28(2):103–110

    Article  PubMed  Google Scholar 

  25. Lim PS, Ng BK, Ali A, Shafiee MN, Kampan NC, Mohamed Ismail NA et al (2014) Successful external cephalic version: factors predicting vaginal birth. ScientificWorldJournal 2014:860107

    PubMed  PubMed Central  Google Scholar 

  26. Salzer L, Nagar R, Melamed N, Wiznitzer A, Peled Y, Yogev Y (2014) Predictors of successful external cephalic version and assessment of success for vaginal delivery. J Mater Fetal Neonatal Med 28(1):49–54

    Article  Google Scholar 

  27. Zandstra H, Mertens HJMM (2013) Improving external cephalic version for foetal breech presentation. Facts Views Vis ObGyn 5(2):85–90

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Pri-Paz S, Khalek N, Fuchs KM, Simpson LL (2012) Maximal amniotic fluid index as a prognostic factor in pregnancies complicated by polyhydramnios. Ultrasound Obstet Gynecol 39(6):648–653

    Article  CAS  PubMed  Google Scholar 

  29. Burgos J, Cobos P, Rodriguez L, Pijoán JI, Fernández-Llebrez L, Martínez-Astorquiza T et al (2012) Clinical score for the outcome of external cephalic version: a two-phase prospective study. Aust N Z J Obstet Gynaecol 52(1):59–61

    Article  PubMed  Google Scholar 

  30. Dudley NJ (2005) A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obstet Gynecol 25(1):80–89

    Article  CAS  PubMed  Google Scholar 

  31. Burgos J, Melchor JC, Cobos P, Centeno M, Pijoan JI, Fernandez-Llebrez L et al (2009) Does fetal weight estimated by ultrasound really affect the success rate of external cephalic version? Acta Obstet Gynecol Scand 88(10):1101–1106

    Article  PubMed  Google Scholar 

  32. Mowat A, Gardener G (2014) Predictors of successful external cephalic version in an Australian maternity hospital. Aust N Z J Obstet Gynaecol 54(1):59–63

    Article  PubMed  Google Scholar 

  33. Obeidat N, Lataifeh I, Al-Khateeb M, Zayed F, Khriesat W, Amarin Z (2011) Factors associated with the success of external cephalic version (ECV) of breech presentation at term. Clin Exp Obstet Gynecol 38(4):386–389

    CAS  PubMed  Google Scholar 

  34. Healey M, Porter R, Galimberti A (1997) Introducing external cephalic version at 36 weeks or more in a district general hospital: a review and an audit. Br J Obstet Gynaecol 104(9):1073–1079

    Article  CAS  PubMed  Google Scholar 

  35. Cho LY, Lau WL, Lo TK, Tang HHT, Leung WC (2012) Predictors of successful outcomes after external cephalic version in singleton term breech pregnancies: a nine-year historical cohort study. Hong Kong Med J 18(1):11–19

    CAS  PubMed  Google Scholar 

  36. Lau TK, Lo KW, Wan D, Rogers MS (1997) Predictors of successful external cephalic version at term: a prospective study. Br J Obstet Gynaecol 104(7):798–802

    Article  CAS  PubMed  Google Scholar 

  37. Aisenbrey GA, Catanzarite VA, Nelson C (1999) External cephalic version: predictors of success. Obstet Gynecol 94(5 Pt 1):783–786

    CAS  PubMed  Google Scholar 

  38. Rosman AN, Guijt A, Vlemmix F, Rijnders M, Mol BWJ, Kok M (2013) Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand 92(2):137–142

    Article  PubMed  Google Scholar 

  39. Yogev Y, Horowitz E, Ben-Haroush A, Chen R, Kaplan B (2002) Changing attitudes toward mode of delivery and external cephalic version in breech presentations. Int J Gynaecol Obstet 79(3):221–224

    Article  CAS  PubMed  Google Scholar 

  40. Reinhard J, Sänger N, Hanker L, Reichenbach L, Yuan J, Herrmann E et al (2013) Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): a prospective trial of vaginal breech versus cephalic delivery. Arch Gynecol Obstet 287(4):663–668

    Article  PubMed  Google Scholar 

  41. Balayla J, Dahdouh EM, Villeneuve S, Boucher M, Gauthier RJ, Audibert F et al (2015) Obstetrical and neonatal outcomes following unsuccessful external cephalic version: a stratified analysis amongst failures, successes, and controls. J Matern Fetal Neonatal Med 28(5):605–610. doi:10.3109/14767058.2014.927429

  42. Kuppens SMI, Hutton EK, Hasaart THM, Aichi N, Wijnen HA, Pop VJM (2013) Mode of delivery following successful external cephalic version: comparison with spontaneous cephalic presentations at delivery. J Obstet Gynaecol Can 35(10):883–888

    Article  PubMed  Google Scholar 

  43. Ben-Haroush A, Perri T, Bar J, Yogev Y, Bar-Hava I, Hod M et al (2002) Mode of delivery following successful external cephalic version. Am J Perinatol 19(7):355–360

    Article  PubMed  Google Scholar 

  44. Vézina Y, Bujold E, Varin J, Marquette GP, Boucher M (2004) Cesarean delivery after successful external cephalic version of breech presentation at term: a comparative study. Am J Obstet Gynecol 190(3):763–768

    Article  PubMed  Google Scholar 

  45. Hants Y, Kabiri D, Elchalal U, Arbel-Alon S, Drukker L, Ezra Y (2015) Induction of labor at term following external cephalic version in nulliparous women is associated with an increased risk of cesarean delivery. Arch Gynecol Obstet 92(2):313–319

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank the staff on the delivery ward and our fellow obstetric consultant (Mrs. Handke-Vesely) for their clinical contribution to this study.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany

    Florian Ebner, Thomas W. P. Friedl, Elena Leinert, Amelie Schramm, Frank Reister, Kristian Lato, Wolfgang Janni & Nikolaus DeGregorio

Authors
  1. Florian Ebner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas W. P. Friedl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elena Leinert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amelie Schramm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank Reister
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kristian Lato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wolfgang Janni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nikolaus DeGregorio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Ebner.

Ethics declarations

Conflict of interest

We declare that we have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ebner, F., Friedl, T.W.P., Leinert, E. et al. Predictors for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet 293, 749–755 (2016). https://doi.org/10.1007/s00404-015-3902-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-015-3902-z

Keywords

Search

Navigation