Mode of childbirth and neonatal outcome after external cephalic version: A prospective cohort study.
OBJECTIVE
to assess the mode of childbirth and adverse neonatal outcomes in women with a breech presentation with or without an external cephalic version attempt, and to compare the mode of childbirth among women with successful ECV to women with a spontaneous cephalic presentation.


METHODS
prospective matched cohort study.


METHODS
25 clusters (hospitals and its referring midwifery practices) in the Netherlands. Data of the Netherlands perinatal registry for the matched cohort.


METHODS
singleton pregnancies from January 2011 to August 2012 with a fetus in breech presentation and a childbirth from 36 weeks gestation onwards. Spontaneous cephalic presentations (selected from national registry 2009 and 2010) were matched in a 2:1 ratio to cephalic presentations after a successful version attempt. Matching criteria were maternal age, parity, gestational age at childbirth and fetal gender. Main outcomes were mode of childbirth and neonatal outcomes.


RESULTS
of 1613 women eligible for external cephalic version, 1169 (72.5%) received an ECV attempt. The overall caesarean childbirth rate was significantly lower compared to women who did not receive a version attempt (57% versus 87%; RR 0.66 (0.62-0.70)). Women with a cephalic presentation after ECV compared to women with a spontaneous cephalic presentation had a decreased risk for instrumental vaginal childbirth (RR 0.52 (95% CI 0.29-0.94)) and an increased risk of overall caesarean childbirth (RR 1.7 (95%CI 1.2-2.5)).


CONCLUSIONS
women who had a successful ECV are at increased risk for a caesarean childbirth but overall, ECV is an important tool to reduce the caesarean rate.


CONCLUSIONS
ECV is an important tool to reduce the caesarean section rates.
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands. Electronic address: a.n.rosman@amc.nl.
A N
AN
Rosman
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
F
F
Vlemmix
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
S
S
Ensing
University of Amsterdam, Academic Medical Centre, Clinical Research Unit, The Netherlands.
B C
BC
Opmeer
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
S
S
Te Hoven
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
J
J
Velzel
VU medical center (VUmc), the Netherlands University of Amsterdam, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
M
M
de Hundt
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
S
S
van den Berg
Rode Kruis Hospital, Beverwijk, The Netherlands.
H
H
Rota
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
J A M
JA
van der Post
The Robinson Institute| School of Paediatrics and Reproductive Health, University of Adelaide, 5000 SA, Australia.
B W J
BW
Mol
University of Amsterdam, Academic Medical Center, Department of Obstetrics & Gynaecology, Amsterdam, The Netherlands.
M
M
Kok
D000328:Adult; D001946:Breech Presentation / Q000401:mortality; D002585:Cesarean Section / Q000009:adverse effects / Q000401:mortality; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000592:standards*; D005260:Female; D005865:Gestational Age; D006700:Home Childbirth / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D009426:Netherlands; D010298:Parity; D036801:Parturition; D063868:Patient Outcome Assessment; D011247:Pregnancy; D011446:Prospective Studies; D014710:Version, Fetal / Q000379:methods / Q000401:mortality / Q000592:standards*
Breech presentation; External cephalic version; Mode of childbirth; Neonatal outcome