Effectiveness and safety of adjunct interventions for external cephalic version in breech presentation: a systematic review and meta-analysis.
Allanis Cristina Bortoli, Vitor Costa Rozan Fortunato
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed adjunct and procedural strategies for external cephalic version (ECV) in pregnant women with breech presentation, drawing on 10 randomised controlled trials with 2,745 women randomised. Across 2,722 women with complete primary outcome data, adjunct strategies were associated with greater ECV success than standard care, placebo, or expectant management (RR 1.53; 95% CI 1.15-2.04; I² = 87%). Pharmacological tocolysis showed the largest reported effect. The analysis did not establish a reduction in caesarean delivery, and serious maternal and neonatal complications were uncommon.
Key findings
- Adjunct and implementation-related strategies were associated with higher ECV success (RR 1.53; 95% CI 1.15-2.04; I² = 87%).
- Pharmacological tocolysis had the largest reported effect on ECV success (RR 2.39; 95% CI 1.39-4.11).
- Neuraxial anesthesia (RR 1.75; 95% CI 1.07-2.85) and systemic analgesia (RR 1.39; 95% CI 1.15-1.69) were also associated with higher success.
- Caesarean delivery was not significantly reduced (RR 0.88; 95% CI 0.76-1.02); serious maternal and neonatal complications were uncommon.
Why it matters
ECV success can affect whether breech presentation is resolved before birth, and this synthesis suggests that some adjuncts may improve the chance of a successful procedure. However, higher version success did not translate into a demonstrated reduction in caesarean delivery. The findings therefore distinguish procedural success from downstream delivery outcomes and support considering both when interpreting the evidence.
What to keep in mind
The pooled estimate had substantial heterogeneity (I² = 87%), and the review included only 10 trials. The abstract does not provide detailed estimates for serious complications.