(1097) External Cephalic Version with a previous cesarean delivery. Is it worth a try?

Objective: To evaluate the safety, efficacy and labor outcomes of external cephalic version in patients with a previous cesarean delivery.

Study Design: A retrospective cohort study was conducted at a single university-affiliated medical centre between the years 2012-2018. Patients  with a previous cesarean delivery (PCD) who were referred for an external cephalic version (ECV) at term comprised the study group. Outcomes were compared to patients who underwent ECV with no prior cesarean delivery. The primary outcome was ECV success. Secondary outcomes included mode of delivery and composite adverse outcomes (uterine rupture, inverted T incision, obstetric anal sphincter injury, 5 minute Apgar score < 7, umbilical cord pH < 7.1, NICU admission and neonatal sepsis).

Results: 946 patients underwent an ECV. 83 patients had a prior cesarean delivery and comprised the study group. Outcomes were compared to 863 patients without a PCD. There were no clinically significant between-group differences in maternal age (31.6± 4.6 Vs 28.9± 5.9, p< 0.001), parity (4.3±2.4 Vs 2.9±2.8 p< 0.001), gestational age at ECV (38.2±1.3 Vs 38.0±1.1 p=0.09) or birthweight (3338.0±440.9 Vs 3298.1±454.2 p=0.44). Patients with a prior cesarean delivery were just as likely to have a successful ECV (79.5% Vs 75.4% OR 1.3 95% CI 0.7-2.3 p=0.41) and did not have an increased risk of cesarean delivery (28.9% Vs 30.0% OR 0.95 95% CI 0.6-1.5 p=0.8), operative vaginal delivery (10.8% Vs 8.2% OR 1.4 95% CI 0.6-2.7p=0.4) or combined adverse outcomes (14.5% Vs 11.9% OR 1.3 95% CI 0.6-2.3 p=0.5) compared to controls. Of the 66 patients with a PCD who had successful ECV, 20 (30.3%) underwent induction of labor and 46(69.7%) were managed expectantly. Patients who underwent induction of labor had a significantly higher risk of cesarean delivery (25% Vs 6.5% OR 4.5 95% CI p=0.04) but no significant increase in the rate of combined adverse outcome (10% Vs 19.6% OR 0.5 95% CI 0.9-2.3 p=0.48).

Conclusion: External cephalic version in patients with a previous cesarean delivery is safe, effective and not associated with an increased risk of cesarean delivery.