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Obstetrics & Gynecology 2004;104:155-160
© 2004 by The American College of Obstetricians and Gynecologists
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REVIEWS

Intrapartum Cesarean Delivery After Successful External Cephalic Version

A Meta-Analysis

L Y. Chan, MMedSc, MPH, J L. Tang, PhD, K F. Tsoi, BSc, W Y. Fok, MBChB, L W. Chan, MBChB and T K. Lau, MD

From the Department of Obstetrics and Gynaecology and Department of Community and Family Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; and The Chinese Cochrane Center Hong Kong Branch, Hong Kong.

Address reprint requests to: L. Y. Chan, Room 520N, HAHO Building, 147B Argyle Street, Kowloon, Hong Kong; e-mail: lyschan{at}cuhk.edu.hk.

OBJECTIVE: We sought to estimate whether the risk of intrapartum cesarean delivery is higher in pregnancies after successful external cephalic version.

DATA SOURCES: We searched the MEDLINE, PubMed, EMBASE, and Cochrane Library databases to identify relevant studies. Abstracts of the American College of Obstetricians and Gynecologists Annual Clinical Meeting and the Society for Maternal-Fetal Medicine Annual Meeting were searched by hand.

STUDY SELECTION: Studies published between 1980 and 2002 that provided data allowing us to estimate the cesarean rate in both pregnancies after successful version and spontaneous cephalic-presenting pregnancies were selected.

TABULATION, INTEGRATION, AND RESULTS: Relative risks (RRs) and 95% confidence intervals (CIs) between the 2 compared groups were calculated. We used a meta-analysis to assess the heterogeneity of the studies and to combine the results from the included studies. Six eligible studies were identified. The cesarean rate was 27.6% in pregnancies after successful version and 12.5% in cephalic-presenting pregnancies. The combined RR and 95% CI was 2.04 (1.43–2.91). The increased cesarean rate in pregnancies after successful version was accounted for primarily by a higher incidence of emergency cesarean delivery for dystocia and fetal distress; the RR (95% CI) for these 2 events was 2.19 (1.38–3.48) and 2.10 (1.18–3.75), respectively.

CONCLUSION: The intrapartum cesarean delivery rate after successful version is 2 times that in pregnancies where there is spontaneous cephalic presentation. Pregnancies after successful version should not be considered the same as a normal pregnancy.




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J. M Nicholson
Non-cephalic presentation in late pregnancy
BMJ, September 16, 2006; 333(7568): 562 - 563.
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