From the Research
The timing of an urgent cesarean section after a failed external cephalic version (ECV) should occur immediately if complications arise, such as abnormal fetal heart rate patterns, placental abruption, or uterine rupture, as evidenced by the most recent study 1.
Clinical Considerations
The decision to proceed with an urgent cesarean section after a failed ECV depends on various clinical factors, including the presence of complications, gestational age, and the overall health of the mother and fetus.
- In cases where the version fails but no acute complications occur, the cesarean may be scheduled later that day or on a subsequent day depending on gestational age and other clinical factors.
- Prior to attempting ECV, it's essential to have operating facilities readily available with anesthesia and surgical teams on standby precisely because of the potential need for urgent intervention.
Evidence-Based Practice
The most recent study 1 provides evidence that ECV is a relatively successful and low-risk procedure compared to women without a previous caesarean delivery, with ECV success rates and subsequent vaginal delivery rates ranging from 50 to 100% and from 50 to 74.9%, respectively.
- This study also reports that ECV complications included abnormal fetal heart rate, abnormal cardiotocography, and transient vaginal bleeding, but no cases of uterine rupture were reported.
- Another study 2 also found that external cephalic version in women with a prior cesarean section is safe, with a success rate of 50%, and enables a vaginal birth in about a third of women.
Recommendations
Based on the most recent and highest quality evidence 1, it is recommended that ECV be offered to women with one previous caesarean delivery, and that urgent cesarean section be performed immediately if complications arise.
- It is also essential to have a multidisciplinary team available, including obstetricians, anesthesiologists, and neonatologists, to manage any potential complications that may arise during or after the ECV procedure.
- The use of external cephalic version can produce considerable cost savings in the management of the breech fetus at term, as noted in an earlier study 3.