Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women

Asaf Bilgory; Olena Minich; Maria Shvaikovsky; Genady Gurevich; Joseph B. Lessing; Ioana Olteanu

doi:10.1055/s-0041-1739505

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(15): 1679-1686
DOI: 10.1055/s-0041-1739505

Original Article

Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women

Asaf Bilgory

¹Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

,

Olena Minich

¹Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

,

Maria Shvaikovsky

¹Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

,

Genady Gurevich

¹Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

,

Joseph B. Lessing

¹Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

,

Ioana Olteanu

¹Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

› Author Affiliations

Abstract

Objective Our aim was to find the factors which predict a vertex presentation vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV).

Study Design This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis.

Results A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI]: 3.90–7.52, p < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12–0.37, p < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI: 1.03–2.92, p = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model (p = 0.836).

Conclusion Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor.

Key Points

The goal of ECV is to achieve a vertex VD.
Predictors for ECV success might not predict a VD.
Parity & AFI independently predict a VD after ECV.

Keywords

breech presentation - cesarean delivery - external cephalic version - fetal weight - vertex presentation - vaginal delivery

Full Text

References

References
1 Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2015; (04) CD000083
2 Cruikshank DP, White CA. Obstetric malpresentations: twenty years' experience. Am J Obstet Gynecol 1973; 116 (08) 1097-1104
3 Wood EC, Forster FM. Oblique and transverse foetal lie. J Obstet Gynaecol Br Emp 1959; 66 (01) 75-81
4 Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Term Breech Trial Collaborative Group. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000; 356 (9239): 1375-1383
5 Ezra Y, Elram T, Plotkin V, Elchalal U. Significance of success rate of external cephalic versions and vaginal breech deliveries in counseling women with breech presentation at term. Eur J Obstet Gynecol Reprod Biol 2000; 90 (01) 63-66
6 Management of breech presentation: green-top guideline no. 20b. BJOG 2017; 124 (07) e151-e177
7 Women's Health Committee. Management of breech presentation at term. Clinical guidance statement. First endorsed by RANZCOG: February 2001, Current: July 2021
8 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. External cephalic version: ACOG practice bulletin, number 221. Obstet Gynecol 2020; 135 (05) e203-e212
9 Chan LY, Tang JL, Tsoi KF, Fok WY, Chan LW, Lau TK. Intrapartum cesarean delivery after successful external cephalic version: a meta-analysis. Obstet Gynecol 2004; 104 (01) 155-160
10 Clock C, Kurtzman J, White J, Chung JH. Cesarean risk after successful external cephalic version: a matched, retrospective analysis. J Perinatol 2009; 29 (02) 96-100
11 Matsuzaki S, Shimoya K, Murata Y. Cesarean delivery after successful external cephalic version of breech presentation at term. Int J Gynaecol Obstet 2006; 93 (03) 248-249
12 de Hundt M, Velzel J, de Groot CJ, Mol BW, Kok M. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol 2014; 123 (06) 1327-1334
13 Ebner F, Friedl TWP, Leinert E. et al. Predictors for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet 2016; 293 (04) 749-755
14 Mowat A, Gardener G. Predictors of successful external cephalic version in an Australian maternity hospital. Aust N Z J Obstet Gynaecol 2014; 54 (01) 59-63
15 Newman RB, Peacock BS, VanDorsten JP, Hunt HH. Predicting success of external cephalic version. Am J Obstet Gynecol 1993;169(2 Pt 1):245–249, discussion 249–250
16 Kok M, van der Steeg JW, van der Post JAM, Mol BWJ. Prediction of success of external cephalic version after 36 weeks. Am J Perinatol 2011; 28 (02) 103-110
17 Kean LH, Suwanrath C, Gargari SS, Sahota DS, James DK. A comparison of fetal behaviour in breech and cephalic presentations at term. Br J Obstet Gynaecol 1999; 106 (11) 1209-1213
18 Vézina Y, Bujold E, Varin J, Marquette GP, Boucher M. Cesarean delivery after successful external cephalic version of breech presentation at term: a comparative study. Am J Obstet Gynecol 2004; 190 (03) 763-768
19 Lurie S, Shalev A, Sadan O, Golan A. The changing indications and rates of cesarean section in one academic center over a 16-year period (1997-2012). Taiwan J Obstet Gynecol 2016; 55 (04) 499-502
20 Macara LM, Murphy KW. The contribution of dystocia to the cesarean section rate. Am J Obstet Gynecol 1994; 171 (01) 71-77
21 Leitch CR, Walker JJ. The rise in caesarean section rate: the same indications but a lower threshold. Br J Obstet Gynaecol 1998; 105 (06) 621-626
22 Kabiri D, Elram T, Aboo-Dia M, Elami-Suzin M, Elchalal U, Ezra Y. Timing of delivery after external cephalic version and the risk for cesarean delivery. Obstet Gynecol 2011; 118 (2 Pt 1): 209-213
23 Aisenbrey GA, Catanzarite VA, Nelson C. External cephalic version: predictors of success. Obstet Gynecol 1999; 94 (5 Pt 1): 783-786
24 Burgos J, Melchor JC, Pijoán JI, Cobos P, Fernández-Llebrez L, Martínez-Astorquiza T. A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term. Int J Gynaecol Obstet 2011; 112 (01) 48-51
25 Lau TK, Lo KW, Wan D, Rogers MS. Predictors of successful external cephalic version at term: a prospective study. Br J Obstet Gynaecol 1997; 104 (07) 798-802
26 Kim GJ. Reviving external cephalic version: a review of its efficacy, safety, and technical aspects. Obstet Gynecol Sci 2019; 62 (06) 371-381
27 Melo P, Georgiou EX, Hedditch A, Ellaway P, Impey L. External cephalic version at term: a cohort study of 18 years' experience. BJOG 2019; 126 (04) 493-499
28 Grootscholten K, Kok M, Oei SG, Mol BWJ, van der Post JA. External cephalic version-related risks: a meta-analysis. Obstet Gynecol 2008; 112 (05) 1143-1151
29 Collins S, Ellaway P, Harrington D, Pandit M, Impey LWM. The complications of external cephalic version: results from 805 consecutive attempts. BJOG 2007; 114 (05) 636-638
30 Pergialiotis V, Bellos I, Fanaki M, Vrachnis N, Doumouchtsis SK. Risk factors for severe perineal trauma during childbirth: an updated meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247: 94-100
31 Sandström A, Altman M, Cnattingius S, Johansson S, Ahlberg M, Stephansson O. Durations of second stage of labor and pushing, and adverse neonatal outcomes: a population-based cohort study. J Perinatol 2017; 37 (03) 236-242
32 Heinonen K, Saisto T, Gissler M, Kaijomaa M, Sarvilinna N. Rising trends in the incidence of shoulder dystocia and development of a novel shoulder dystocia risk score tool: a nationwide population-based study of 800 484 Finnish deliveries. Acta Obstet Gynecol Scand 2021; 100 (03) 538-547
33 Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 2001; 345 (01) 3-8