To compare the mode of delivery among women with singleton breech presentation at 36 weeks who attempted external cephalic version (ECV) with those who declined the procedure, in a tertiary center characterized by a low ECV success rate and a high rate of planned vaginal breech delivery.

We conducted a retrospective observational study in a tertiary maternity unit between January 2016 and December 2018. All women with singleton breech presentation at 36 weeks and eligible for vaginal delivery and ECV were included. Women with contraindications to vaginal delivery or ECV were excluded. Two groups were defined: women who attempted ECV (ECV group) and women who declined ECV (no ECV group). The primary outcome was the overall cesarean delivery rate. Secondary outcomes included presentation at delivery, timing of cesarean delivery, ECV complications, and neonatal outcomes.

Among 15,833 births, 434 eligible women were included: 390 (89.7%) attempted ECV and 44 (10.3%) declined. The ECV success rate was 27.7%. Cephalic presentation at delivery was significantly more frequent in the ECV group (31.0% vs 0%, p<0.001). However, the overall cesarean delivery rate did not significantly differ between the ECV and no ECV groups (51.3% vs 36.4%, p=0.07). Compared with women who declined ECV, cesarean delivery was significantly lower after successful ECV (20.4% vs 36.4%, p=0.04) but significantly higher after failed ECV (63.1% vs 36.4%, p<0.001). Neonatal outcomes did not differ between groups.

In a setting with a low ECV success rate and a high rate of successful vaginal breech delivery, ECV was not associated with lower cesarean delivery rate, despite higher rate of cephalic presentation at birth. These findings suggest that the effectiveness of ECV in reducing cesarean delivery may depend on local success rates and institutional expertise in vaginal breech delivery.