Mode of Childbirth and Neonatal Outcome After External Cephalic Version: A Prospective Cohort Study

Midwifery. 2016 Aug;39:44-8. doi: 10.1016/j.midw.2016.02.014. Epub 2016 Mar 3.


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.

Design: prospective matched cohort study.

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

Participants: 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.

Measurements and findings: 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)).

Key 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.

Implication for practice: ECV is an important tool to reduce the caesarean section rates.

Keywords: Breech presentation; External cephalic version; Mode of childbirth; Neonatal outcome.

MeSH terms

  • Adult
  • Breech Presentation / mortality
  • Cesarean Section / adverse effects
  • Cesarean Section / mortality
  • Cohort Studies
  • Delivery, Obstetric / methods*
  • Delivery, Obstetric / standards*
  • Female
  • Gestational Age
  • Home Childbirth / adverse effects
  • Home Childbirth / mortality
  • Humans
  • Infant, Newborn
  • Maternal Age
  • Netherlands
  • Parity
  • Parturition
  • Patient Outcome Assessment*
  • Pregnancy
  • Prospective Studies
  • Version, Fetal / methods
  • Version, Fetal / mortality
  • Version, Fetal / standards*