External Cephalic Version Success Rate and Associated Factors: Experience from a Tertiary Center in Sub-Saharan Africa: A Cross-sectional Study

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Abstract Background: External cephalic version (ECV), which is now routinely offered in developed countries, is not a popular procedure in the developing regions, such as Sub-Saharan Africa (9). There is also scarce data on success rate of ECV from this developing region of Africa. The aim of this study was to determine the success rate of ECV and it’s associated factors in an Ethiopian setting.Methods: A total of 152 ECVs performed at the St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia from June 1, 2018 up to March 30, 2019 were analyzed, using a cross-sectional study design. Patients with breech presentation were recruited at 36 weeks of gestation or more during antenatal consultations and ECV procedures were provided by Maternal-Fetal-Medicine (MFM) specialist or MFM fellow at Ultrasound room. Data was analyzed using SPSS version 21. Chi-square test of association was done for categorical data analysis. Multivariate logistic regression analysis was used to determine predictors of success of ECV. Odds ratio, 95% CI, and P-value were used to describe findings’ significanceResults: The success rate of ECV was 71.7%. Multiparous women had a 1.4-times higher probability of success than nulliparous women (95% CI, 0.07-2.35); thin abdominal wall had 3.5 fold increased success rate ( 95% CI, 0.29-42.40) ; unengaged breech had a 1.1 higher probably of success than engaged(95% CI, 0.26-4.74); a posterior placental location increased the success rate by 1.14 times compared with an anterior placenta (95% CI, 1.03–2.60); the odds of successful ECV was 14.68((95% CI, 1.65–34.97) when cases experienced no pain during the procedure ; and tense uterine tone was associated a lower success rate as compared to soft tone (AOR= 0.08 ,95% CI, 0.016—0.39). Eighty-four percent of those mothers who had successful ECV had spontaneous vertex vaginal delivery.Conclusion: The success rate of ECV in this study is found to be 71.7%, which is higher than reports from previous studies. Multiparty, absence of pain during procedure, posterior placenta, unengaged breech, soft uterine tone, and thin abdominal wall were significantly associated with ECV success.Précis: The success rate of ECV in this study is found to be 71.7%, which is higher than reports from previous studies.

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