EFFICACY OF EXTERNAL CEPHALIC VERSION - A REVIEW

Objective: To assess the efficacy of external cephalic version, includ ing safety, cost-benefit analysis, and impact on the cesarean delivery rate. Data sources: A MEDLINE search was conducted to identify all ar ticles published in English between 1980-1991 on external cephalic ver sion. References were also cross-checked for all reports. Methods of s tudy selection: We reviewed only those articles providing sufficiently detailed data to determine actual numbers of subjects. In cases of du plicate results, only the latest publication was used. Rates of succes sful version, cesarean delivery, and fetal and maternal complications were presented. Data extraction and synthesis: Among the United States trials, the success rate was approximately 65% (range 48-77%), and on ce version succeeded, almost all the fetuses stayed in the vertex posi tion until birth. Among those in whom external version was performed, the mean cesarean delivery rate was 37%, compared with 83% in controls (P < .001). External version would also save 12.3% of the costs of de livering breech patients overall. Conclusion: External cephalic versio n is safe and cost-effective. It substantially reduces the cesarean de livery rate among breech presentations, decreases the risk related to breech delivery, and avoids cesarean delivery in subsequent pregnancie s. However, external version will not have a major impact on the high overall cesarean birth rate.