title: Successful external cephalic version: factors predicting vaginal birth.
abstract: OBJECTIVE
  To determine the maternal and fetal outcomes of successful external cephalic version (ECV) as well as factors predicting vaginal birth.
  
  
  METHODS
  The ECV data over a period of three years at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 1 September 2008 and 30 September 2010 was reviewed. Sixty-seven patients who had successful ECV were studied and reviewed for maternal, fetal, and labour outcomes. The control group comprised patients with cephalic singletons of matching parity who delivered following the index cases.
  
  
  RESULTS
  The mean gestational age at ECV was 263 ± 6.52 days (37.5 weeks ± 6.52 days). Spontaneous labour and transient cardiotocographic (CTG) changes were the commonest early adverse effects following ECV. The reversion rate was 7.46%. The mean gestational age at delivery of the two groups was significantly different (P = 0.000) with 277.9 ± 8.91 days and 269.9 ± 9.68 days in the study group and control groups, respectively. The study group needed significantly more inductions of labour. They required more operative deliveries, had more blood loss at delivery, a higher incidence of meconium-stained liquor, and more cord around the neck. Previous flexed breeches had a threefold increase in caesarean section rate compared to previous extended breeches (44.1% versus 15.2%, P = 0.010). On the contrary, an amniotic fluid index (AFI) of 13 or more is significantly associated with a higher rate of vaginal birth (86.8% versus 48.3%, P = 0.001).
  
  
  CONCLUSIONS
  Patients with successful ECV were at higher risk of carrying the pregnancy beyond 40 weeks and needing induction of labour, with a higher rate of caesarean section and higher rates of obstetrics complications. Extended breech and AFI 13 or more were significantly more likely to deliver vaginally postsuccessful ECV. This additional information may be useful to caution a patient with breech that ECV does not bring them to behave exactly like a normal cephalic, so that they have more realistic expectations. However, these predictive factors needed further confirmation and hopefully, in the future, they would be able to further enhance counselling prior to ECV.
authors.affiliation: Department of Obstetrics and Gynaecology, UKM Medical Centre, Malaysia.
authors.forename: Pei Shan
authors.initials: PS
authors.lastname: Lim
authors.affiliation: Department of Obstetrics and Gynaecology, UKM Medical Centre, Malaysia.
authors.forename: Beng Kwang
authors.initials: BK
authors.lastname: Ng
authors.affiliation: Department of Obstetrics and Gynaecology, UPM, Malaysia.
authors.forename: Anizah
authors.initials: A
authors.lastname: Ali
authors.affiliation: Department of Obstetrics and Gynaecology, UKM Medical Centre, Malaysia.
authors.forename: Mohamad Nasir
authors.initials: MN
authors.lastname: Shafiee
authors.affiliation: Department of Obstetrics and Gynaecology, UKM Medical Centre, Malaysia.
authors.forename: Nirmala Chandralega
authors.initials: NC
authors.lastname: Kampan
authors.affiliation: Department of Obstetrics and Gynaecology, UKM Medical Centre, Malaysia.
authors.forename: Nor Azlin
authors.initials: NA
authors.lastname: Mohamed Ismail
authors.affiliation: Department of Obstetrics and Gynaecology, UKM Medical Centre, Malaysia.
authors.forename: Mohd Hashim
authors.initials: MH
authors.lastname: Omar
authors.affiliation: Department of Obstetrics and Gynaecology, UKM Medical Centre, Malaysia.
authors.forename: Zaleha
authors.initials: Z
authors.lastname: Abdullah Mahdy
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal; D014710:Version, Fetal / Q000379:methods*