Enhancing external cephalic version success: insights from an Israeli tertiary center

Objectives: With global cesarean delivery rates steadily rising, a more accessible and widely adopted approach to external cephalic version for breech presentations is essential. This study seeks to clarify controversial factors associated with the procedure's success and highlight the favorable fetal-maternal outcomes post-procedure to support its broader, guideline-based application where indicated. Methods: This observational study was conducted over 7 years at Soroka University Medical Center, including healthy pregnant women with breech fetal presentation at a minimum of 36 weeks. The procedure was performed by experienced obstetricians with over 10 years of expertise. Results: Out of 262 women who underwent the procedure, a 60% success rate was achieved. Success was associated with factors such as parity and higher fetal weight, while BMI and placental location did not impact outcomes. Successful procedures were linked to increased rates of vaginal birth (p<0.001), longer gestational age at delivery (p<0.001), and higher birth weight (p<0.02) compared to failed versions. No significant adverse maternal or fetal outcomes were noted during or after the procedure. Conclusions: External cephalic version is a safe and effective method for reducing the rate of cesarean deliveries. Additionally, babies born after the procedure tend to have a higher gestational age and birth weight. We recommend factoring physician experience into predictive models and advocate for the widespread inclusion of simulation-based training in residency programs to enhance obstetricians' confidence and skills worldwide, promoting its broader use.