Intrapartum cesarean delivery after successful external cephalic version: a meta-analysis.

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.