Predictors of successful external cephalic version at term: a prospective study

Abstract

Objective: To investigate clinical and ultrasonographic predictors of outcome of external cephalic version at term.

Design: Prospective observational study.

Setting: University obstetric unit.

Population: All external cephalic versions performed over two years (n = 243).

Methods: Nineteen different clinical and ultrasonographic variables were recorded before each procedure. The ability of each of the 19 variables to predict the success or failure of external cephalic version was assessed by univariate analysis. The study population was then divided into two subgroups of 129 and 114 patients by random allocation using computer generated numbers. Logistic regression was performed in each subgroup to assess the relative importance and independence of the important variables. The derived regression models were then applied to the other subgroup of patients to assess accuracy and reproducibility.

Results: The overall success rate of the procedure was 69.5%. Both regression models identified the same three variables as independent predictors of failed versions: 1. presenting part engaged; 2. difficult to palpate the fetal head, and 3. a tense uterus on palpation. The two models correctly predicted 75.2% and 84.2% of outcomes in the other subgroup. If uterine tone, which was assessed after administration of tocolytic, was excluded from the analysis, the other two factors remained in the models, with the addition of nulliparity as a significant predictor of failed external cephalic version. The chance of success of external cephalic version in the original 243 women was found to be < 20% if two of these variables were present, 0% if all three were present, and 94% if none were present.

Conclusions: The outcome of external cephalic version can be predicted by easily available clinical parameters.