Factors Influencing the Success of Breech External Cephalic Version and Their Impact on Delivery Mode and Maternal-Neonatal Outcomes

This prospective cohort study aimed to identify factors influencing the success rate of external cephalic version (ECV) and to evaluate its impact on delivery mode and maternal-neonatal outcomes. Conducted at Jinniu District Maternal and Child Health Hospital (Chengdu, China) between May 2021 and January 2024, the study enrolled 62 pregnant women with singleton breech presentations at or beyond 37 weeks of gestation. Baseline characteristics of the ECV success (n=51) and failure (n=11) groups were compared, with predictors analyzed using multivariable logistic regression. Results identified five independent predictors of ECV success: lower maternal body mass index (BMI) at delivery (OR=0.816, 95% CI 0.662–0.991; P=0.042), prior spontaneous vaginal delivery (OR=8.250, 95% CI 1.879–58.080; P=0.012), non-posterior placental location (OR=0.171, 95% CI 0.034–0.678; P=0.017), higher amniotic fluid index (OR=1.442, 95% CI 1.053–2.185; P=0.048), and fewer ECV attempts (OR=0.174, 95% CI 0.059–0.375; P=0.001). The ECV success group had a significantly higher vaginal delivery rate (81% vs. 0%; P=0.012) and a lower cesarean delivery rate (19% vs. 100%) compared to the failure group. Neonates in the success group also exhibited higher birth weights (3266.4 ± 352.54 g vs. 3063.2 ± 202.93 g; P=0.017). These findings indicate that ECV is an effective intervention for reducing cesarean delivery rates and improving perinatal outcomes. Clinical protocols should be tailored to individual patient characteristics, particularly the identified predictors. While this study provides evidence for ECV’s clinical utility, future research with larger cohorts and extended follow-up is needed to validate long-term outcomes. The results underscore ECV’s potential to alleviate healthcare burdens and enhance maternal-neonatal health through informed decision-making.