{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:37:08Z","timestamp":1792093028863,"version":"4.4.0"},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Malpresentation is the indication for approximately 17% of primary cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. Our primary objective is to identify associations between patient demographics and rate of ECV attempt. Secondary objectives include determining the rate of ECV attempt in the United States, and assessing neonatal and maternal outcomes associated with ECV attempt.<\/jats:p>\n                  <jats:p>Data were obtained from the National Center for Health Statistics birth certificate data from 2014 to 2021. We analyzed live, singleton, non-anomalous births at term (37\u201342 weeks). Observations lacking complete information on the mode of delivery, presentation at delivery, or whether an ECV was attempted were excluded. We reasoned that subjects who either had an ECV attempt or were non-cephalic at the time of delivery constituted an ECV-eligible cohort. The association between patient characteristics and ECV attempts was examined using logistic regression to obtain odds ratios and 95% confidence intervals.<\/jats:p>\n                  <jats:p>A total of 30,656,644 deliveries were recorded in the database from 2014 to 2021, and 925,082 subjects met inclusion criteria and were considered ECV-eligible. Only 7.9% of the ECV-eligible population had an ECV attempt. Non-Hispanic Black and Hispanic race\/ethnicity, unmarried status, lack of a college degree, non-private insurance, delayed prenatal care, increased age, lower parity, one prior CD, and increased BMI were associated with decreased rates of ECV attempt. In regards to neonatal and maternal outcomes, differences were statistically significant but absolute differences were small.<\/jats:p>\n                  <jats:p>Our findings are limited by the quality of data collection, but strongly suggest that ECV is underutilized and not uniformly offered to patients. We identified patient characteristics including race and other demographics that were associated with decreased rates of ECV attempt, and found no clinically significant differences in neonatal or maternal outcomes with ECV attempt other than decreased CD rate.<\/jats:p>","DOI":"10.1055\/a-2849-7694","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T22:58:14Z","timestamp":1775861894000},"page":"1961-1968","source":"Crossref","is-referenced-by-count":1,"title":["Characteristics and Outcomes Associated with the Attempt of External Cephalic Version in U.S. Birth Certificate Data"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8265-1742","authenticated-orcid":false,"given":"Alison","family":"Verster","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Easha","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Ramus","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and is the Division Head of the Division of Maternal-Fetal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Robinson","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Richmond, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Springel","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine under the Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"issue":"04","key":"ref1","first-page":"CD000083","article-title":"External cephalic version for breech presentation at term","volume":"2015","author":"G J Hofmeyr","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"9239","key":"ref2","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/S0140-6736(00)02840-3","article-title":"Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial","volume":"356","author":"M E Hannah","year":"2000","journal-title":"Lancet"},{"issue":"07","key":"ref3","first-page":"e178","article-title":"External cephalic version and reducing the incidence of term breech presentation: Green-top Guideline No. 20a","volume":"124","year":"2017","journal-title":"BJOG"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ajog.2014.01.026","article-title":"Safe prevention of the primary cesarean delivery","volume":"210","author":"A B Caughey","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/1471-0528.13234","article-title":"An observational study of the success and complications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwives","volume":"123","author":"A Beuckens","year":"2016","journal-title":"BJOG"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1186\/s12884-017-1430-5","article-title":"Uptake of external cephalic version for term breech presentation: an Australian population study, 2002-2012","volume":"17","author":"Y S Bin","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"102165","DOI":"10.1016\/j.jogoh.2021.102165","article-title":"External cephalic version: predictors for success","volume":"50","author":"L Cillard","year":"2021","journal-title":"J Gynecol Obstet Hum Reprod"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.ajog.2023.05.027","article-title":"Role of individual physicians in success of external cephalic version","volume":"229","author":"M N Naert","year":"2023","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/AOG.0000000000004620","article-title":"Racial and ethnic inequities in cesarean birth and maternal morbidity in a low-risk, nulliparous cohort","volume":"139","author":"M P Debbink","year":"2022","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.midw.2013.03.013","article-title":"Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands","volume":"30","author":"A N Rosman","year":"2014","journal-title":"Midwifery"},{"issue":"04","key":"ref12","first-page":"1","article-title":"Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013","volume":"64","author":"S C Curtin","year":"2015","journal-title":"Natl Vital Stat Rep"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2849-7694.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:06:56Z","timestamp":1790896016000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2849-7694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":11,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,10,1]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2849-7694","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4,10]]},"published":{"date-parts":[[2026,4,10]]}}}