(1146) ECV Attempts by year and race/ethnicity in the United States from 2011-2018

Per the SMFM and ACOG 2014 Safe Prevention of the Primary Cesarean Delivery, those with fetal malpresentation should be offered external cephalic version (ECV) to allow for vaginal delivery. In this study, we examine trends in ECV attempt rates over time in the United States.

Study Design: A retrospective study on singleton, non-anomalous, term deliveries with attempted ECV or identified breech presentation at delivery in the U.S. from 2011-2018 using birth certificate data. We identified individuals who underwent an ECV attempt regardless of success. We used Chi-squared tests and multivariable regression to examine the association of race/ethnicity with ECV attempts, controlled for maternal age, BMI, parity, education, prenatal visits, smoking, and insurance status.

Results: Of 853,528 individuals who fit our inclusion criteria, 62,227 (7.29%) attempted ECV. The rate of attempted ECV decreased from 2011 (8.33%) to 2013 (5.78%) and increased each year from 2013 to 2018 (7.29%). Statistically significant differences in ECV attempt rates exist between years (p < 0.001). As compared with individuals who identify as White, Black (aOR 0.75; 95% CI 0.73, 0.78), Hispanic (aOR 0.63; 95% CI 0.61, 0.65), and Asian (aOR 0.72; 95% CI 0.69, 0.75) were less likely to attempt ECV when controlling for confounding variables. AI/AN individuals were more likely to attempt ECV (aOR 1.74; 95% CI 1.59, 1.91). Trends within every race/ethnicity groups follow the overall trend of decreasing until 2013 and subsequently increasing.

Conclusion: From 2011 to 2013 the rate of attempted ECV decreased and then increased annually beginning in 2014. It is possible that the changes in rates are in part due to the ACOG/SMFM guidance as well as a change in population characteristics. Additionally, those who identified as Black, Hispanic, and Asian race/ethnicity were less likely to undergo ECV. Further work should assess structural causes of these differences.