Obstetric outcomes after instituting a dedicated External Cephalic Version clinic in a large tertiary centre: a 3-year prospective cohort study

Abstract

Aim: External cephalic version (ECV) is the main intervention for facilitating vaginal birth without increasing intrapartum mortality and neonatal morbidity in term breech pregnancies. We appraise the hypothesis that the introduction of a specialised ECV clinic reduces preventable caesareans without compromising neonatal well-being. Methods: This is a prospective cohort study over a period of 3 years. Data were collected via attendance in the ECV clinic and women were followed up until the delivery and the postnatal period. Obstetric and neonatal notes were reviewed in order to assess obstetric data and fetal outcomes. Results: 181 suitable women with singleton pregnancy were included in our sample, from which 28 opted for elective caesarean delivery. 81% of the eligible women underwent an ECV. From the 120 ECVs performed, 78 women were nulliparous and 42 multiparous. The ECV was successful in a total of 64 cases (54%), 49% in nulliparous and 62% in multiparous women. Following that, 78% delivered vaginally of which 25% needed instrumental delivery. There were not any adverse events during the ECVs and no woman underwent emergency caesarean section for fetal distress due to the procedure. Conclusion: Our experience favours the ECV clinic, as it improves vaginal delivery rates with no obvious maternal and neonatal compromise. Cost-effectiveness and maternal satisfaction levels remain unknown. There is still room for improvement in detection, uptake and success ECV rates.