EXTERNAL CEPHALIC VERSION AT A MILITARY TEACHING HOSPITAL - PREDICTORS OF SUCCESS

The purpose of this prospective study was to analyze our experience wi th external cephalic version under tocolysis. This included an expecte d (1) high success rate of version, (2) infrequent occurrence of rever sion, (3) reduction in the incidence of intrapartum breech presentatio n, avoiding the need for Caesarean delivery, and (4) predictors of suc cess in our series. The study spanned the period from 1985 to 1993, en rolling 113 subjects who presented to our OB/GYN Department with any t ype of breech presentation at 37 weeks' gestation or greater and met t he following criteria: (1) absence of labour or ruptured membranes, (2 ) singleton pregnancy, (3) absence of medical or obstetrical complicat ions and amniotic fluid index of greater than 8 cm. After a reassuring fetal assessment, IV terbutaline was given prior to an attempt at ver sion. The results revealed a 46% (53 or 113) version success rate with a 4% (2 of 53) reversion within a week after procedure. There was a 2 % (2 of 113) complication rate, with 1 being a minor incident of fetal bradycardia that responded easily to intrauterine resuscitation. One major complication occurred with placental abruption during the attemp t, which required immediate Caesarean delivery. Predictors of success in our series included: multiparity, fundal/posterior placenta, and fe tal head and spine on the corresponding side of the maternal sagittal plane. External cephalic version in a controlled setting can be a safe procedure for residents in training that lowers Caesarean delivery ra te for breech presentation.