Breech

Question 1

When is ECV offered?

Answer 1

Offered at TERM from 37+0 onwards
Can offer from 36+0 in nulliparous women

(Spontaneous version is more common in multiparous women)

Question 2

How effective is ECV?

Answer 2

50% success rate

Successful ECV reduces chance of C-section

If unsuccessful (after 36+0wks), only few babies spontaneously turn to cephalic position

Question 3

Risks of ECV?

Answer 3

With appropriate precautions, complications associated with ECV are very rare

Labour after ECV is associated with a slightly increased rate of C-section and instrumental delivery when compared with spontaneous cephalic presentation

Question 4

Is there a way to improve success rate of ECV?

Answer 4

Tocolysis using beta-agonists (IV salbutamol) improves the success rates of ECV

Also some evidence of regional anaesthesia reducing failure rates, particularly in conjunction with tocolysis.
However, routine use of regional analgesia or neuraxial blocks is not recommended. Only consider for repeat attempts or for women unable to tolerate ECV without analgesia.

Question 5

Contraindications to ECV?

Answer 5

No general consensus (limited evidence) but considered contraindicated in the following circumstances:

• Placental abruption
• Severe pre-eclampsia
• Signs of fetal distress (CTG, HR)
• If reason for C-section exists (e.g. placenta praevia major)
• Multiparity (unless 1st twin already delivered)
• Current/recent (<1wk) vaginal bleeding
• ROM

ECV after one caesarean delivery appears to have no greater risk than with an unscarred uterus.

Question 6

What measures need to be taken to ensure fetal safety?

Answer 6

• ECV should be performed where facilities for monitoring and surgical delivery are available.
• Fetal CTG + HR monitoring before, during and after ECV
• Women undergoing ECV who are Rhesus D-negative should undergo testing for fetomaternal haemorrhage and be offered anti-D.

Urgent delivery if there is vaginal bleeding or unexplained abdominal pain, or if an abnormal CTG persists.