The influence of advanced maternal age on the success rate, delivery mode and maternal and fetal outcomes of pregnant women undergoing external cephalic version: a retrospective cohort study

Advanced maternal age (AMA) is associated with a higher rate of cesarean sections. Non-cephalic presentation is an important cause of cesarean delivery, and external cephalic version (ECV) offers an opportunity for vaginal trial of labor for these women. However, the influence of advanced age on the success rate of ECV and the ensuing obstetric outcomes remains to be elucidated. We conducted a retrospective, single-center cohort study of women with singleton pregnancies who underwent an ECV for breech or shoulder presentation at a tertiary, university-affiliated medical center from January 2016 to September 2023. Data were extracted from routine hospital records. The success rates of ECV and subsequent delivery outcomes were compared between the AMA group and controls. A total of 448 ECV procedures were analyzed in this study, including 81 AMA cases and 367 controls. The success rate of converting to a cephalic presentation was 75.31% (61/81) for the AMA group and 74.93% (275/367) for controls, with no significant difference (p = 0.943). Of the women who underwent ECV, 214 delivered at our hospital. The vaginal delivery rate was 68.18% (30/44) for the AMA group and 73.53% (125/170) for controls, showing no significant difference (p = 0.479). Further, a comparative analysis of maternal and neonatal outcomes following post-ECV vaginal delivery revealed no significant differences between the AMA group and controls. In this retrospective cohort, ECV success and short-term obstetric outcomes were comparable between AMA and younger women. Generalisability is limited by the single-centre design, exclusion of scarred uteri, and loss of follow-up for deliveries outside our hospital. Larger, multicentre prospective studies—including women with prior caesarean—are required before definitive recommendations can be made.