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Licensed Unlicensed Requires Authentication Published by De Gruyter March 18, 2021

Risk factors and outcomes of abnormal bleeding after external cephalic version

  • Hitoshi Matsui , Kohei Ogawa EMAIL logo , Aikou Okamoto and Haruhiko Sago



To present the consequences of and risk factors for abnormal bleeding after ECV (external cephalic version).


We conducted a retrospective chart review at a single center in Japan. Abnormal bleeding was defined as vaginal bleeding and/or intrauterine hemorrhage. We descriptively assessed birth outcomes among women with abnormal bleeding, and investigated the risk factors using a logistic regression analysis.


Of 477 women who received ECV, 39 (8.2%) showed abnormal bleeding, including 16 (3.4%) with intrauterine hemorrhage. Of the 16 women with intrauterine hemorrhage, 14 required emergency cesarean section; none experienced placental abruption, a low Apgar score at 5 min (<7), or low umbilical cord artery pH (<7.1). Among 23 women who had vaginal bleeding without intrauterine hemorrhage, four cases underwent emergency cesarean section and one case of vaginal delivery involved placental abruption. The risk of abnormal bleeding was higher in women with a maximum vertical pocket (MVP) of <40 mm in comparison to those with an MVP of >50 mm (adjusted odds ratio [OR]: 3.48, 95% confidence interval [CI]: 1.23–9.90), as was higher in women with unsuccessful ECV than in those with successful ECV (aOR: 4.54, 95% CI: 1.95–10.6).


A certain number of women who underwent ECV had abnormal bleeding, including vaginal bleeding and/or intrauterine hemorrhage, many of them resulted in emergency cesarean section. Although all of cases with abnormal bleeding had good birth outcomes, one case of vaginal bleeding was accompanied by placental abruption. Small amniotic fluid volume and unsuccessful ECV are risk factors for abnormal bleeding.

Corresponding author: Kohei Ogawa, MD, PhD, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan, Phone: +81 3 3416 0181, Fax: +81 3 3416 2222, E-mail:


The authors are deeply grateful to all of the participants in the present study and to the hospital staff for their cooperation. We would also like to thank the following members of an ECV team: Terumi Miwa, Yukiko Tazaki, and Fumio Suyama. The authors would also like to thank Mr. Brian Quinn, for proofreading and editing this manuscript.

  1. Research funding: None declared.

  2. Author contributions: HM and KO initiated the concept, designed the study, and collected the data, and KO analyzed the data. HM wrote the initial manuscript. AO and HS gave critical comments on the study design and interpretation and revised the draft.

  3. Competing interests: All the authors have no conflicts of interest to disclose.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the Institutional Review Board of the NCCHD on Nov. 15, 2018 (No 1990).


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Received: 2020-09-24
Accepted: 2021-03-01
Published Online: 2021-03-18
Published in Print: 2021-07-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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