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External cephalic version

Author
G Justus Hofmeyr, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

External cephalic version (ECV) refers to a procedure in which the fetus is rotated from the breech to the cephalic presentation by manipulation through the mother's abdomen (figure 1). It is typically performed as an elective procedure in nonlaboring women at or near term to improve their chances of having a vaginal cephalic birth. Women most likely to opt for ECV are those who are well-informed, encouraged to undergo the procedure, believe in its safety, and desire a vaginal delivery [1]. Women may choose not to undergo ECV because of fear of the procedure, incomplete information, and preference for scheduled cesarean delivery.

This topic will discuss the procedure for ECV. The causes, diagnosis, management, and outcome of breech presentation are reviewed separately. (See "Overview of breech presentation".)

EFFECTIVENESS

The effectiveness of ECV is based on its ability to increase the proportion of fetuses in cephalic presentation at birth and decrease the frequency of cesarean delivery. The effectiveness of ECV was illustrated by a 2012 systematic review of seven randomized trials of ECV at term [2]. Compared with women with breech fetuses who had no attempt at ECV, women who attempted ECV approximately halved their risks of both noncephalic birth (relative risk [RR] 0.46, 95% CI 0.31-0.66) and cesarean delivery (RR 0.63, 95% CI 0.44-0.90).

Although ECV decreases the frequency of cesarean delivery compared with no ECV, the cesarean delivery rate after successful ECV remains higher than in the general obstetrical population. In a 2014 meta-analysis of observational studies of mode of delivery after successful ECV, the cesarean delivery rate after successful ECV was twice as high as the rate in women with cephalic-presenting fetuses and no ECV (21 versus 11 percent; RR 2.19, 95% CI 1.73-2.76) [3]. The excess risk of cesarean delivery was due to both dystocia and nonreassuring fetal heart rate patterns.

There is no clear explanation for the increased frequency of dystocia after successful ECV. One theory is that factors common to both breech presentation and successful ECV, such as an unengaged presenting part or small maternal pelvis, are also risk factors for dystocia. Parity also plays a role in risk of dystocia. Multiparous women are more likely than nulliparas to give birth vaginally after successful ECV [4,5].

                               

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Literature review current through: Apr 2015. | This topic last updated: Mar 10, 2015.
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