Comparison of external cephalic version outcomes among pregnant women with different gestational weight gains under combined neuraxial analgesia and tocolysis - a retrospective study

Sep 30, 2026

Uploaded by Ben

External cephalic version (ECV) is an established approach to reduce cesarean section rates in fetal malpresentation, yet the role of gestational weight gain (GWG) in ECV success remains insufficiently defined. This retrospective study assessed GWG patterns and their association with ECV success under combined neuraxial analgesia and tocolysis. Pregnant women were classified using 2021 Chinese Nutrition Society guidelines and evaluated by primary success rate with multivariate adjustment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Ma etal. BMC Pregnancy and Childbirth (2026) 26:22 [https://doi.org/10.1186/s12884-025-08281-w](https://doi.org/10.1186/s12884-025-08281-w) BMC Pregnancy and Childbirth RESEARCH Open Access Comparison of external cephalic version outcomes among pregnant women with different gestational weight gains under combined neuraxial analgesia and tocolysis: a retrospective study Li Ma 1†, Zizhu Wang 1†, Jiurong Li4 and Shen Sun2,3* Abstract Background External cephalic version (ECV) is an established method for reducing cesarean section rates in fetal mal presentation. While gestational weight gain (GWG) may influence ECV success, evidence remains limited. We evaluated the impact of GWG patterns on ECV success rates under combined neuraxial analgesia and tocolysis. Methods We included pregnant women undergoing ECV with neuraxial analgesia and tocolysis at Fudan University Obstetrics and Gynecology Hospital (2018–2024) . Participants were classified according to 2021 Chinese Nutrition Society (CNS) guidelines as having below-target, within-target, or above-target GWG. Primary outcome was ECV success rate. Multivariate logistic regression assessed the association between GWG and success, adjusting for maternal factors. Results Among 319 eligible cases, ECV success rates varied across GWG categories: 87 . 7%(below-target), 72. 2%(within-target), and 64. 8%(above-target) (p = 0 . 029) . After adjustment for confounders, both within-target GWG (adjusted OR 0 . 304, 95% CI 0 .099–0. 938, p = 0 . 044) and above-target GWG (adjusted OR 0 . 250, 95% CI 0.087–0. 719, p = 0 . 019) demonstrated significantly reduced ECV success compared to below-target GWG. Non-anterior placental position (adjusted OR 1. 908, 95% CI 1.134–3. 201, p = 0 . 014) and higher amniotic fluid index (AFI) (adjusted OR 1.009 per mm increase, 95% CI 1.001–1. 017, p = 0 . 018) were positively associated with ECV success. Conclusions Pregnant women with below-target GWG showed significantly higher ECV success rates under combined neuraxial analgesia and tocolysis. Non-anterior placental position and higher AFI were additionally associated with procedural success. These findings may optimize patient selection and enhance pre-procedure counselling for ECV attempts. †Li Ma and Zizhu Wang contributed equally to this work. *Correspondence: Shen Sun [sunshen1980@126.com](sunshen1980@126.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Ma et al. BMC Pregnancy and Childbirth (2026) 26:22 Page 2 of 7 Trial registration The clinical trial registration number is ChiCTR2500098423/ [https://www.chictr.org.cn/showproj.ht](https://www.chictr.org.cn/showproj.ht)[ml? proj=258486](ml? proj=258486 Date of registration 03/7/2025.)[ Date of registration 03/7/2025.](ml? proj=258486 Date of registration 03/7/2025.) Keywords External cephalic version, Gestational weight gain,

FAQs

What is the main purpose of this study?

To evaluate how different gestational weight gain (GWG) patterns influence external cephalic version (ECV) success rates when neuraxial analgesia and tocolysis are combined.

How were participants grouped by gestational weight gain?

Participants were classified as below-target, within-target, or above-target GWG according to the 2021 Chinese Nutrition Society (CNS) guidelines.

Which factors were associated with ECV success after adjustment?

Non-anterior placental position and higher amniotic fluid index (AFI) were positively associated with ECV success, while within-target and above-target GWG showed reduced ECV success compared with below-target GWG.

Sep 30, 2026

Uploaded by Ben