What is the likelihood of successful external cephalic version at 36 weeks + 4 days in a gravida 3 woman with a frank breech presentation, fetal weight 6 lb 2 oz, normal‑sized uterus and adequate amniotic fluid?

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Success Rate for External Cephalic Version at 36+4 Weeks in Your Clinical Scenario

Based on your specific characteristics—third pregnancy, frank breech, adequate amniotic fluid, and fetal weight of 6 lb 2 oz—your chance of successful ECV is approximately 60-70%.

Your Favorable Predictors

Your clinical profile includes several factors that significantly improve ECV success rates:

Multiparity (Most Important Factor)

  • Being pregnant with your third baby is the strongest predictor of ECV success. Women with at least one prior vaginal delivery have significantly higher success rates compared to first-time mothers 1, 2.
  • Multiparity independently predicts successful ECV with an odds ratio that makes success 2-3 times more likely 1.

Adequate Amniotic Fluid

  • Your "good" amniotic fluid volume is a critical favorable factor. Increased or normal amniotic fluid index is one of the three most significant independent predictors of ECV success 1, 2.
  • Women with normal amniotic fluid have substantially higher success rates compared to those with oligohydramnios 2, 3.

Fetal Weight

  • Your baby's estimated weight of 6 lb 2 oz (approximately 2,780 grams) is another favorable predictor. Increasing estimated fetal weight is associated with higher ECV success rates 1, 2.
  • Larger fetuses are easier to manipulate externally than smaller ones 1.

Frank Breech Presentation

  • Frank breech (legs extended upward) is generally more favorable for ECV than complete or footling breech, though this varies by study 3.

Quantifying Your Success Probability

Based on prediction models that incorporate your specific factors:

  • Women with multiparity, normal amniotic fluid, and adequate fetal weight have success rates exceeding 60% 2, 3.
  • One validated prediction model correctly classified 98.8% of successful ECVs and demonstrated that women with your profile fall into the "good chance of success" category (>60%) 3.
  • Overall success rates in recent studies range from 67-72%, but your multiparity and favorable fluid status place you above this average 1, 4, 3.

Timing Considerations

  • Your gestational age of 36+4 weeks is optimal for ECV. Most protocols recommend attempting ECV between 36-38 weeks 4.
  • Earlier attempts (34-36 weeks) may have slightly higher initial success but carry a 10-15% risk of spontaneous reversion back to breech 4, 5.
  • At 36+4 weeks, if successful, the risk of reversion is lower (approximately 3-5%) 5.

Important Caveats

Placental Location Matters

  • If your placenta is anterior (on the front wall of your uterus), this reduces success rates by approximately 20-30% 2, 3.
  • Posterior or fundal placental location is more favorable 3.
  • Ensure your provider documents placental location before the procedure.

Baby's Position Details

  • Whether the baby's back is on your left or right side, and whether the head is easily palpable, also influences success 3.
  • Frank breech with the fetal spine lateral or posterior tends to be more favorable 3.

If First Attempt Fails

  • If the initial ECV is unsuccessful, a repeat attempt can be considered, though success rates for second attempts are lower (approximately 30-40%) 5.
  • Some centers offer repeat attempts with different techniques or additional tocolysis 4.

Reversion Risk

  • If your ECV is successful, there is approximately a 3-5% chance the baby will spontaneously flip back to breech before labor 5.
  • This risk is higher if the ECV is performed before 37 weeks 4.
  • If reversion occurs, a second ECV can be attempted with a 76% success rate, though this leads to cesarean delivery in 33% of cases 5.

Safety Profile

  • ECV at your gestational age is very safe, with serious complications occurring in less than 1-2% of cases 4, 3.
  • Complications are mostly mild and include transient fetal heart rate changes, minor placental abruption, or premature rupture of membranes 4.
  • No deliveries occurred within 48 hours after ECV in one large series 1.

Post-ECV Vaginal Delivery Rates

  • If your ECV is successful, you have approximately a 77% chance of vaginal delivery 3.
  • This is substantially higher than the vaginal breech delivery rate and avoids the risks of planned cesarean section 3.

References

2
Research

Prediction of success of external cephalic version after 36 weeks.

American journal of perinatology, 2011

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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