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Version success more likely in lower BMI, multiparous breech pregnancies

Key clinical point: Multiparity, larger forebag size, and lower BMI are predictors of external cephalic version success.

Major finding: Model of external cephalic version success shows prediction accuracy of 92%.

Study details: A single-center retrospective cohort study in 250 women with breech presentation.

Disclosures: None of the authors declared any relevant financial disclosures, and there was no external funding.

Source: Isakov O et al. Obstet Gynecol. 2019;133:869-78.

Citation:

Isakov O et al. Obstet Gynecol. 2019;133:869-78.

Commentary:

With cesarean delivery rates rising, there is a need for vigilance to prevent them from returning to the 2009 peak of 33% of deliveries, and ECV is one strategy to help reduce cesarean rates. While there are some risks associated with ECV, which could contribute to negative attitudes, the lack of acceptance of this procedure may be improved if clinicians can provide an individualized estimate for the chance of success. This study proposes creating a predictive model that discriminates between poor and good changes of ECV success.

The fact that this study is a single-center study with a single physician performing all the procedures does limit its generalizability. However the authors’ use of ultrasound measurements of the forebag is a novel contribution that provides an objective measure of this factor, as well as an objective estimate of the engagement of the breech, which has been lacking.

Dr. Gayle Olson Koutrouvelis is a professor of obstetrics, gynecology, and maternal-fetal medicine at the University of Texas Medical Branch in Galveston. These comments are adapted from an editorial accompanying the article by Isakov et al. (Obstet Gynecol. 2019; 133:855-6.). She declared no conflicts of interest.