external cephalic version

Last reviewed 01/2018

• this is a possible treatment option for a breech presentation

• this procedure aims to turn the presentation from breech to cephalic. This achieved via manoeuvring the breech through a forward somersault. Less commonly, the breech is turned via a backward somersault. This procedure is only indicated if a vaginal delivery is planned

• generally this procedure is undertaken at 34-36 weeks. If tocolysis is used, this procedure may be undertaken from 37 weeks

• the success rate of this procedure is approximately 50%

• this procedure may result in fetomaternal transfusion, a positive Kleihauer test and fetal bradycardia. Other complications include abruption and uterine rupture

• contraindications include a previous caesarian section, antepartum haemorrhage, placenta praevia, multiple pregnancy, small-for-dates babies, hypertension or pre-eclampsia

A systematic review concerning the use of external cephalic version (ECV) for breech presentation before term has been undertaken (1):

• compared with no ECV attempt, ECV commenced before term reduces non-cephalic births
• compared with ECV at term, beginning ECV at between 34 to 35 weeks may have some benefit in terms of decreasing the rate of non-cephalic presentation, and caesarean section
• the authors however noted that further trials are needed to confirm this finding and to rule out increased rates of preterm birth, or other adverse perinatal outcomes

Reference:

1. Hutton EF et al. External cephalic version for breech presentation before term. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD000084