#221 External Cephalic Version

Question 1

What % of term pregnancies are breech presentation?

Answer 1

3-4%

Question 2

What % of eligible women are not offered external cephalic version?

Answer 2

20-30%

Question 3

When should fetal presentation start being assessed and documented?

Answer 3

Beginning at 36w0d to allow for ECV

Question 4

At what gestational age should you start offering external cephalic version? Why?

Answer 4

37w0d. If spontaneous version was to happen, should happen by 37w. Spontaneous reversion after ECV is decreased after 37w. If complications arise during attempted ECV, emergency CS of a term infant can be accomplished

Question 5

What is the success rate of external cephalic version in women with a previous cesarean section?

Answer 5

50-84%

Question 6

What is the risk of uterine rupture with external cephalic version in women with prior CS?

Answer 6

None reported

Question 7

Can you attempt an external cephalic version during early labor?

Answer 7

Yes. Success rate of 65% in a previous study

Question 8

How do women with persistent breech presentations compare to those who underwent successful ECV in terms of hospital charge, length of hospital stay, odds of endometritis, sepsis.

Answer 8

women who underwent successful ECV had lower hospital charges, reduced total length of hospital stay, and lower odds of developing endometritis, sepsis, and length of hospital stay greater than 7 days

Question 9

How does external cephalic version affect the risk of low Apgar scores, low umbilical vein pH, or neonatal death?

Answer 9

No effect

Question 10

What adverse events have been reported after external cephalic version?

Answer 10

Abruptio placentae, umbilical cord prolapse, rupture of membranes, stillbirth, and fetomaternal hemorrhage (all rates <1%)

Question 11

What is the average success rate of external cephalic version?

Answer 11

58%

Question 12

What is the complication rate of external cephalic version?

Answer 12

6.1%

Question 13

What factors are associated with successful external cephalic version?

Answer 13

Increasing parity, transverse or oblique presentation, lower hospital cesarean rate

Question 14

What factors are more often associated with external cephalic version failure?

Answer 14

Nulliparity, advanced dilation, fetal weight <2500g, anterior placenta, low station

Question 15

Should tocolysis be used during external cephalic version? If so, which one(s)?

Answer 15

Use of parenteral tocolysis improves success of ECV. Use beta-simulant tocolysis. Do not use nitric oxide donors. Insufficient evidence for calcium channel blockers

Question 16

True or false, successful external cephalic version does not affect cesarean section rate?

Answer 16

False. ECV is associated with an overall reduction in cesarean births.

Question 17

What is the recommendation regarding neuraxial analgesia for external cephalic version?

Answer 17

Neuraxial analgesia in combo with tocolytic therapy can be considered reasonable to increase ECV success rate. Data insufficient to conclusively evaluate neuraxial analgesia without tocolysis to make a recommendation during ECV attempts.

Question 18

Do you need to monitor fetal heart rate and contractions before an ECV, after, or both?

Answer 18

Both

Question 19

When should you abandon an external cephalic version?

Answer 19

Prolonged fetal bradycardia, discomfort to patient, cannot be easily completed

Question 20

Do you need to give rhogam to Rh D negative mothers after external cephalic version?

Answer 20

Yes, if delivery is not anticipated in the next 72 hours