Risk factors for caesarean section and instrumental vaginal delivery after successful external cephalic

Chapter 4 Abstract OBJECTIVE To examine if we could identify factors that predict caesarean section and instrumental vaginal delivery in women who had a successful external cephalic version. METHODS We used data from a previous randomized trial among 25 hospitals and their referring midwife practices in the Netherlands. With the data of this trial we performed a cohort study among women attempting vaginal delivery after successful external cephalic version. We evaluated whether maternal age, gestational age, parity, time interval between external cephalic version and delivery, birthweight, neonatal gender, and induction of labour were predictive for a vaginal delivery on one hand or a caesarean section or instrumental vaginal delivery on the other hand. Unadjusted and adjusted odds ratios were calculated with univariate and multivariate logistic regression analysis. RESULTS Among 301 women who attempted vaginal delivery after successful external cephalic version, the caesarean section rate was 13% and the instrumental vaginal delivery rate 6%, resulting in a combined operative delivery rate of 19%. Nulliparity increased the risk of caesarean section (OR 2.7 (95% CI 1.2-6. 1)) and operative delivery (OR 4.2 (95% CI 2. 1-8.6)). Maternal age, gestational age at delivery, time interval between external cephalic version and delivery, birthweight and neonatal gender did not contribute to the prediction of failed spontaneous vaginal delivery. CONCLUSIONS In our cohort of 301 women with a successful external cephalic version, nulliparity was the only factor that predicted the risk for caesarean section and instrumental vaginal delivery.