External cephalic version

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Way to turn breech babies during pregnancy

title: "External cephalic version" type: doc version: 1 created: 2026-02-28 author: "Wikipedia contributors" status: active scope: public tags: ["obstetrical-procedures"] description: "Way to turn breech babies during pregnancy" topic_path: "general/obstetrical-procedures" source: "https://en.wikipedia.org/wiki/External_cephalic_version" license: "CC BY-SA 4.0" wikipedia_page_id: 0 wikipedia_revision_id: 0

::summary Way to turn breech babies during pregnancy ::

::data[format=table title="Infobox interventions |"]

FieldValue
NameExternal cephalic version
ImageAs tabula IX and Child presenting feet Wellcome L0009819.jpg
CaptionChild presenting head first (top) and feet first (bottom)
specialtyObstetrics
ICD10
ICD9
MeshID
OPS301
OtherCodes
::

Name = External cephalic version | Image = As tabula IX and Child presenting feet Wellcome L0009819.jpg| Caption = Child presenting head first (top) and feet first (bottom)| specialty = Obstetrics| ICD10 = | ICD9 = | MeshID = | OPS301 = | OtherCodes = | HCPCSlevel2 = 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, preferably 37 weeks, and can even be performed in the early stages of childbirth.

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.

Medical use

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.

Success rates

ECV has an average success rate of around 58%, between 40 and 64% depending on whether it is the mother's first child or not. (40% for first-time mothers and closer to 60% for women who have had previous children.

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.

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.

Contra-indications

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.

Risks

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.

Evidence of complications of ECV from clinical trials is limited, but ECV does reduce the chance of breech presentation at birth and caesarian section. The 2015 Cochrane review concluded that "large observational studies suggest that complications are rare".

Typical risks include umbilical cord entanglement, abruption of placenta, preterm labor, premature rupture of the membranes (PROM) and severe maternal discomfort. Overall complication rates have ranged from about 1 to 2 percent since 1979. While somewhat out of favour between 1970 and 1980, the procedure has seen an increase in use due to its relative safety.

Successful ECV significantly decreases the rate of cesarean section, however, women are still at an increased risk of instrumental delivery (ventouse and forceps delivery) and cesarean section compared to women with spontaneous cephalic presentation (head first).

Technique

The procedure is undertaken by either one or two physicians and where emergency facilities to undertake instrumental delivery and caesarian section are at hand. Blood is also taken for cross-matching should a complication arise.

The procedure usually lasts a few minutes and is monitored intermittently with CTG. With a covering of ultrasonic gel on the abdomen to reduce friction, The procedure is discontinued if maternal distress, repeated failure or fetal compromise on monitoring occurs.

ECV performed before term may decrease the rate of breech presentation compared to ECV at term, but may increase the risk of preterm delivery. There is some evidence to support the use of tocolytic drugs in ECV. Given by injection, tocolytics relax the uterus muscle and may improve the chance of turning the baby successfully. This is considered safe for the mother and baby, but can cause the mother to experience facial flushing and a feeling of a fast heart rate. Use of intravenous nitroglycerin has been proposed.

Following the procedure, a repeat CTG is performed and a repeat ultrasound will confirm a successful turn. Should this first attempt fail, a second attempt on another day can be considered.

In addition, to prevent Rh disease after the procedure, all rhesus D negative pregnant women are offered an intramuscular injection of anti-Rh antibodies (Rho(D) immune globulin).

History

ECV has existed since 384–322 B.C., the time of Aristotle. Justus Heinrich Wigand published an account of ECV in 1807 and the procedure was increasingly accepted following Adolphe Pinard's demonstration of it in France. In 1901, British obstetrician, Herbert R. Spencer, advocated ECV in his publication on breech birth. In 1927, obstetrician George Frederick Gibberd, reviewed 9,000 consecutive births around Guy's Hospital, London. Following his study, he recommended ECV, even if it failed and needed to be repeated and even if it required anaesthesia.

ECV's safety has continued to be a longstanding controversy. Following a protocol developed in Berlin, ECV did increase in popularity in the United States in the 1980s. The procedure has been increasingly considered as low risk of complications and its improvement in safety as a result of the routine use of electronic fetal monitoring, waiting until closer to term and the replacement of anaesthesia by tocolysis, has seen a recent resurgence.

References

References

  1. (1751). "An essay towards a complete new system of midwifry, theoretical and practical. Together with the descriptions,causes and methods of removing, or relieving the disorderspeculiar to pregnant ... women, and new-born infants". J. Hodges.
  2. Sharoni, L. (March 2015). "Anesthesia and external cephalic version". Current Anesthesiology Reports.
  3. (2020). "External Cephalic Version". StatPearls Publishing.
  4. (July 2017). "Breech baby at the end of pregnancy".
  5. (2017). "Obstetrics Essentials: A Question-Based Review". Springer.
  6. Neely, M. R.. (May 1959). "Combined internal cephalic version". Ulster Medical Journal.
  7. Wight, William. (2008). "Evidence-Based Obstetric Anesthesia". John Wiley & Sons.
  8. (January 2009). "Ultrasound factors to predict the outcome of external cephalic version: a meta-analysis". Ultrasound in Obstetrics and Gynecology.
  9. (2010). "External Cephalic Version and Reducing the Incidence of Breech Presentation".
  10. (2015). "External cephalic version for breech presentation at term". Cochrane Database of Systematic Reviews.
  11. (1998-09-01). "External Cephalic Version". American Family Physician.
  12. (June 2014). "Mode of delivery after successful external cephalic version: a systematic review and meta-analysis.". Obstetrics and Gynecology.
  13. "What Is External Cephalic Version?". WebMD.
  14. Ehrenberg-Buchner, Stacey. (3 August 2018). "External Cephalic Version: Overview, Technique, Periprocedural Care". Medscape.
  15. (29 July 2015). "External cephalic version for breech presentation before term.". The Cochrane Database of Systematic Reviews.
  16. (9 February 2015). "Interventions for helping to turn term breech babies to head first presentation when using external cephalic version.". The Cochrane Database of Systematic Reviews.
  17. (September 2009). "Intravenous nitroglycerin for external cephalic version: a randomized controlled trial". Obstet Gynecol.

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