ECV External Cephalic version - Breech Presentation

• Introduction
• Abortion
• Amenorrhoea
• Birth Control
• Bladder Symptoms
• Cancer in Women
• Childbirth
• Children and Teenagers
• Diet / Weight Loss
• Dysmenorrhoea
• Endometriosis
• Fibroids
• HRT
• Hirsutism
• Hysterectomy
• Infections
• Infertility
• Medication Drugs
• Menopause
• Menorrhagia
• Miscarriage
• Painful Sex
• Pap Smear Test
• PCOS
• Pelvic Pain
• PMS
• Postpartum
• Pregnancy
• Preconception
• Pregnancy Diagnosis
• Pregnancy Calculator
• Pregnancy Calendar
• Antental Care
• Antenatal Classes
• Gestational Age
• Maternal Medical Conditions
• Pregnancy Complications
• Antepartum Haemorrhage
• Breech Presentation
• Gestational Diabetes
• I.U. Growth Retardation
• Morning Sickness
• Obstetric Cholestasis
• Placenta Praevia
• Placental Abruption
• Premature Labour
• Postterm
• Pre-Eclampsia & Eclampsia
• Teen Pregnancy
• Twins / Multiple Pregnancy
• Venous Thrombosis
• Planned Delivery
• Self Esteem
• Sexual Problems
• Vaginal Discharge
• Vaginal Prolapse
• Vulval Symptoms

Breech Presentation - External Cephalic Version

 Pros and cons of external cephalic version (ECV), planned vaginal breech delivery and elective caesarean section

 

In a Cochrane review,^2001-01 ECV appeared to be a safe and effectiveway of reducing the number of elective caesarean sections forbreech presentation but there was not enough evidence to quantifyserious complications. Large observational studies suggest thatthese are uncommon.^2004-01 In this review of 44 studies, which included7 377 participants, transient abnormal heart rate patterns occurredin 5.7% of cases, with persistent abnormality in 0.37%. Othercomplications included vaginal bleeding (0.47%), placental abruption(0.12%) and emergency caesarean section (0.43%). Perinatal mortalitywas 0.16% but this needs to be kept in perspective with an expectedfetal loss rate of 0.6% between 36 and 42 weeks of gestationin a low-risk population. 

It is also clear that ECV should not be offered if ready accessto emergency caesarean section is not available. Busy unitsmay not be able to offer this assurance and this may be a reasonwhy the implementation of ECV is inconsistent.^1997-01 If needed,emergency caesarean section may be performed more quickly undergeneral than epidural anaesthesia but this would require rapidsequence induction. It would seem unreasonable to fast all womenundergoing ECV. Success rates vary between 50?80%. The validity of the contraindicationshas not yet been tested in randomised controlled studies. Fetalheart monitoring is recommended as bradycardia occurs frequentlyand, if persistent, urgent delivery may be required.^1983-01 Use oftocolytic agents improves the success rate of ECV and, at thedoses required, they have few risks or side effects.^2004-02

In a case controlled study^2002-01 the caesarean section rate wasalmost three times higher in a group of 279 women who had undergone

If ECV fails or the procedure is declined, the choice of plannedvaginal breech delivery or elective caesarean section must bediscussed. The two issues of ECV and caesarean section are closelylinked. Counselling and consent issues, therefore, need to beinitiated by the 36-week visit to give the woman sufficienttime to make an informed decision.

Training in ECV is much simpler than for vaginal breech deliveryand it should be included in the formal training programme.Methods and protocols for performing the procedure should bein place.