Cesarean risk after successful external cephalic version: a matched, retrospective analysis

Objective: To determine the odds of cesarean, operative vaginal delivery and vaginal birth after cesarean after successful external cephalic version (ECV) compared with singleton pregnancies eligible for a trial of labor. Study Design: A matched case-control study was performed using the Memorial Care OBStat Database from 1 January 1998 to 31 July 2006. We identified 197 participants who underwent a successful ECV (study group) and compared them with the next two women presenting for labor management, matched for parity, gestational age, delivery history (previous cesarean delivery) and type of labor (spontaneous or induced). Result: There was no significant difference in the adjusted matched odds of cesarean delivery between the study group and control group overall (16.8 vs 11.9%; odds ratio (OR) 1.70; 95% confidence interval (CI) 0.98 to 2.97), even when subanalyzed according to parity. There was also no significant difference in adjusted matched odds of operative vaginal delivery for the study group and control group, 15.9 vs 8.9% (OR 1.06; 95% CI 0.32 to 3.51). Among patients with a prior cesarean, those who underwent successful ECV had a cesarean delivery rate of 11.1% compared with 16.7% in the matched control group (OR 0.59; 95% CI 0.47 to 7.43). Conclusion: Cesarean delivery and operative vaginal delivery rates following successful ECV are not increased in our data set compared with matched controls, even in patients with a prior cesarean delivery. This information may be useful when counseling patients who are contemplating an ECV attempt due to non-cephalic presentation at term. Journal of Perinatology (2009) 29, 96-100; doi:10.1038/jp.2008.227; published online 8 January 2009