Preoperative Predictors of Successful External Cephalic Version with Breech Presentation at Term: A Single-site Study

Background: To determine the factors associated with successful external cephalic version (ECV) of breech presentation at term in China. Methods: Pregnant patients who underwent ECV for a breech presentation at term from January 2020 to January 2023 were included in this retrospective observational study. From the candidate demographic and clinical factors a logistic regression model was employed to detect the predictors of ECV success. A receiver operating characteristic (ROC) curve was constructed to test the discriminative capacity of the final model. Results: The success rate of ECV in 207 pregnancies with a breech presentation at term was 68.6%. The rates of failed ECV after four to five attempts were 45/207 (21.7%), and suspected foetal hypoxia was present in 7 out of 207 (3.38%) babies. Three factors—an increased amniotic fluid index (AFI), the use of terbutaline and lower head circumference to femur length (HC/FL) ratio predicted the probability of a successful ECV. The area under the ROC curve (c-statistics) was 0.735 (95% confidence interval (CI) 0.649–0.800). Conclusions: An increased AFI, use of terbutaline, and a lower HC/FL ratio were all associated with successful ECV and can be used to estimate the chances of ECV success. ECV for breech presentation is a safe procedure with a reasonable success rate which increases the likelihood of a vaginal birth.