External cephalic version

External cephalic version (ECV) is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. It is a manual procedure that is recommended by national guidelines for breech presentation of a pregnancy with a single baby, in order to enable vaginal delivery. It is usually performed late in pregnancy, that is, after 36 gestational weeks, but preferably 37 weeks, and can even be performed in early labour. External cephalic version (ECV) is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. It is a manual procedure that is recommended by national guidelines for breech presentation of a pregnancy with a single baby, in order to enable vaginal delivery. It is usually performed late in pregnancy, that is, after 36 gestational weeks, but preferably 37 weeks, and can even be performed in early labour. ECV is endorsed by the American College of Obstetricians and Gynecologists (ACOG) and Royal College of Obstetricians and Gynaecologists (RCOG) as a mode to avoid the risks associated with a vaginal breech or cesarean delivery for singleton breech presentation. ECV can be contrasted with 'internal cephalic version', which involves a hand inserted through the cervix. ECV is one option of intervention should a breech position of a baby be found after 36 weeks gestation. Other options include a planned caesarian section or planned vaginal delivery. ECV has a success rate between 60 and 75%. Various factors can alter the success rates of ECV. Practitioner experience, maternal weight, obstetric factors such as uterine relaxation, a palpable fetal head, a non-engaged breech, non-anterior placenta, and an amniotic fluid index above 7–10 cm, are all factors which can be associated with higher success rates. In addition, the effect of neuraxial blockade on ECV success rates have been conflicting, although ECV appears easier to perform under epidural block. Reports from a study carried out by the University Kebangsaan Malaysia Medical Centre, between 1 September 2008 and 30 September 2010, indicate that patients in the ECV group with pregnancies which went post dates (beyond 40 weeks), two-thirds had successful vaginal delivery while a third required caesarean section. Within this study the success rate of ECV was 51.4% (73/142 cases) over the three-year period. Following successful ECV, with the baby turned to head first, there is a less than 5% chance of the baby turning spontaneously to breech again. Some situations exist where ECV is not indicated or may cause harm. These include recent antepartum haemorrhage, placenta praevia, abnormal fetal monitoring, ruptured membranes, multiple pregnancy, pre-eclampsia, reduced amniotic fluid and some other abnormalities of the uterus or baby. As with any procedure there can be complications most of which can be greatly decreased by having an experienced professional on the birth team. An ultrasound to estimate a sufficient amount of amniotic fluid and monitoring of the fetus immediately after the procedure can also help minimize risks.