Routine use of external cephalic version in three hospitals

Background: External cephalic version has been advocated as a safe alternat ive to vaginal breech delivery or cesarean birth. The purpose of this study was to determine the efficacy of routine use of external cephalic version at 36 weeks or more of gestation in three different levels of hospitals. Me thods: External cephalic version was performed on 923 women with a single b reech fetus at three hospitals in Italy! The procedure was attempted with a tocolytic agent for uterine relaxation and with no maternal analgesia. The version technique adopted was the "forward roll." Results: Version was suc cessfully performed on 579 fetuses (62.7%): each hospital had a similar suc cess rate, and 56.9 percent of the women delivered vaginally! The procedure was more successful in multiparas and in women with an incomplete type of breech, polyhydramnios, and posterior localization of the placenta. Vaginal bleeding was experienced by 14 women; eight cesarean sections were perform ed for suspected abruptio placentae, confirmed irt four cases. Two cephalic -turned fetuses experienced an episode of persistent bradycardia and were t urned again to breech; in five cases a nonstress test recorded after the ve rsion showed repeated variable decelerations and in one case a cesarean sec tion was performed. Neonatal outcomes were good in 922 infants. A fracture of the femur attributable to the version was observed in one newborn. Concl usions: External cephalic version is effective in reducing the number of ce sarean deliveries in term breech infants in different obstetric settings, w ith no major neonatal adverse outcomes.