Unplanned Cesarean Delivery Following Successful External Cephalic Version

INTRODUCTION: Breech vaginal delivery is a rarely performed procedure. Patients with breech fetuses typically undergo scheduled cesarean delivery. External cephalic version is offered to help reduce cesarean delivery rates. Following successful external cephalic version, patients are not guaranteed vaginal delivery and may be at increased risk of intrapartum cesarean delivery. METHODS: Retrospective cohort study at Kaiser Los Angeles Medical Center comparing delivery outcomes in patients who undergo successful external cephalic version with patients who undergo trial of labor with spontaneously cephalic fetuses at onset of labor. RESULTS: Patients who underwent external cephalic version were more likely to undergo intrapartum cesarean delivery following trial of labor than patients with spontaneously cephalic fetuses (29.2% vs 18.6%) with adjusted odds ratio of 1.9. This was most notable for malpresentation following the onset of labor (1.8% vs 0.01%; OR 11.7) and labor dystocia (20.4% vs 13.8%; OR 1.8). There was also a higher rate of operative vaginal delivery (8% vs 4.8%; OR 1.7), however this was not statistically significant. CONCLUSION: Despite successful external cephalic version, patients are at higher risk of intrapartum cesarean delivery than patients with spontaneously cephalic fetuses. Therefore, patients who undergo successful external cephalic version should not be considered the same as normal spontaneously cephalic pregnancies. However, external cephalic version remains a favorable procedure at our institution as the number needed to treat to prevent one cesarean delivery for breech presentation is 3.7.