(731) Outcomes of a Second External Cephalic Version for Management of Malpresentation

Objective: Patients with fetal malpresentation are routinely offered external cephalic version (ECV). Previous studies have shown that patients who undergo a successful ECV have lower rates of cesarean birth compared to those who do not attempt an ECV. The objective of this study was to describe the outcomes of patients who undergo a second ECV after a failed first attempt or after a successful first attempt with subsequent spontaneous return to breech.

Study Design:

We performed a descriptive retrospective cohort study of individuals who underwent two ECV procedures at a single academic medical center from 7/1/2016 to 12/31/2021. Patients who aborted the ECV procedure prior to completion were excluded from the analysis. The ECV success rate and cesarean birth rate were calculated among those who had one and two ECV attempts. Patient characteristics were compared for individuals with a successful and unsuccessful second ECV attempt using Wilcoxon rank sum and Fisher exact or chi-squared tests, where appropriate. P-values < 0.05 were considered statistically significant. 

Results:

Of the 433 women who underwent an ECV procedure, 44% had a successful version (Figure 1). We identified 65 (15%) women who underwent a second ECV procedure: 53 (82%) had a failed first attempt and 12 (18%) had a spontaneous reversion. The overall ECV success rate on the second attempt was 36.9%. Patients with a successful second ECV procedure had a cesarean birth rate of 29%, compared to 100% of patients with an unsuccessful attempt. Additional patient characteristics can be found in Table 1. The second attempt averted 17 cesarean births (4% of all patients). 

Conclusion:

A second ECV procedure lowers the rate of malpresentation and cesarean delivery. Second attempt success rates were similar to the first attempt, though lower among the cohort who had a failed first ECV. If replicated in other settings and populations, these findings support offering a second ECV attempt for patients motivated to avoid a cesarean delivery for malpresentation.