Attempted external cephalic version not associated with perinatal morbidity

Reference

Son M, Roy A, Grobman WA, Miller ES. Association between attempted external cephalic version and perinatal morbidity and mortality. Obstet Gynecol 2018;132(2):365-370.

Synopsis

These authors sought to determine whether ECV at approximately 37 weeks' gestation was associated with an increased rate of perinatal morbidity and mortality. They included the records of a retrospective cohort of women who had fetal malpresentation at near term, including, footling breech, complete breech, frank breech, and transverse lie. Included women were at least 18 years old, had a nonanomalous singleton pregnancy, and received prenatal care before 36 weeks' gestation at the single institution of the authors. Women were excluded if they had a prior cesarean delivery, cavity-entering myomectomy, or placenta previa. Of 4117 eligible women 1263 (31%) had an attempted ECV. Version was attempted under neuraxial analgesia and after administration of a subcutaneous dose of terbutaline 0.25 mg. The study sample was large enough to detect a 1 percentage point difference between the groups undergoing and not undergoing version in a composite endpoint for fetal morbidity and mortality. Elements of the composite included stillbirth, neonatal death within 72 hours after birth, Apgar score less than 5 at 5 minutes, umbilical artery pH less than 7.0, base deficit 12 mmol/L (216 mg/dL) or greater, or neonatal hypothermia. There were no significant differences between groups for this primary outcome (2.9% vs 2.5%; P = 0.46) or any of its components. There were also no significant differences in the secondary outcomes of neonatal intensive care admission or neonatal anemia. Women who underwent ECV had a cesarean rate for any indication of 66% compared with 99% for those who did not. Of those who attempted ECV 1.8% underwent cesarean delivery at the time of the procedure for nonreassuring fetal status.