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.