Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study

Objective: To determine if external cephalic version (ECV) can be performed with safety and efficacy in women with previous caesarean section.

Design: Prospective comparative cohort study.

Setting: Cruces University Hospital (Spain).

Population: Single pregnancy with breech presentation at term.

Methods: We compared 70 ECV performed in women with previous caesarean section with 387 ECV performed in multiparous women (March 2002 to June 2012).

Main outcome measures: Success rate, complications of the ECV and caesarean section rate.

Results: The success rate of ECV in women after previous caesarean section was 67.1% versus 66.1% in multiparous women (P = 0.87). The logistic regression analysis confirmed this result (odds ratio 0.93, 95% CI 0.52-1.68; P = 0.82) adjusted by the variables associated with success of ECV. There were no complications in the previous caesarean section cohort. The vaginal delivery rate in the previous caesarean section cohort was 52.8% versus 74.9% in the multiparous cohort (P < 0.01). There were no cases of uterine rupture.

Conclusion: Based on our data, we conclude that complications are uncommon with ECV in women with previous caesarean section, with a success rate comparable to that of multiparous women. Uterine scar should not be considered a contraindication and ECV should be offered to women with previous caesarean section with breech presentation at term.