Predicting the success of external cephalic version with a scoring system - A prospective, two-phase study

OBJECTIVE: To develop a noninvasive and quantifiable scoring system based o n clinical parameters to predict the success of external cephalic version ( ECV) in women with breech presentation at term. STUDY DESIGN: This was a prospective, two-phase, clinical study. Phase 1 wa s to develop a scoring system from 53 versions with singleton pregnancy ii? breech presentation at term using a standard protocol with fetal monitorin g, ultrasound assessment and tocolysis. Phase 2 was to verify this scoring system-2 by application to 88 versions using the same standard protocol as in phase 1. RESULTS: The success rates for ECV in phases I and 2 were 64.2% and 61.4%, respectively, making the overall success rate 62.4%. The results of phase 1 showed that there were significant differences in the following parameters : head palpable, breech unengagement, symphysis-fundal height and uterine r elaxation. A scoring system based on these four clinical parameters was dev eloped. When applied to 88 versions in the second phase, the likelihood rat io of successful ECV was >30 if the version score was greater than or equal to 3 and <1.8 if the version score was less than or equal to 2. CONCLUSION: Using our scoring system, prediction of successful ECV was poss ible without ultrasound scan or vaginal examination, and counseling could b e given once breech presentation was diagnosed.