External Cephalic Version and Reducing the Incidence of Term Breech Presentation

Question 1

How effective is ECV in preventing noncephalic birth?

Answer 1

• success rate of ECV is approximately 50%.
• after unsuccessful ECV attempt at 36+0 wks or later, few babies presenting by breech will spontaneously turn to cephalic presentation.
• few babies revert to breech after successful ECV.
• successful ECV reduces the chance of CS.

Question 2

Does ECV affect the outcome of labour?

Answer 2

• labour after ECV is associated with a slightly increased rate of CS and instrumental delivery when compared with spontaneous cephalic presentation.

Question 3

Can the success of an ECV attempt be predicted?

Answer 3

ECV success can be predicted to some extent, but the use of models to predict success should not be used routinely to determine whether ECV can be attempted.

Question 4

What methods can be used to improve the success rate of ECV?

Answer 4

Use of tocolysis with betamimetics improves the success rates of ECV. A
Routine use of regional analgesia or neuraxial blockade is not recommended, but may be
considered for a repeat attempt or for women unable to tolerate ECV without analgesia.
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Question 5

When should ECV be offered?

Answer 5

• at term from 37+0 weeks of gestation.

- In nulliparous, ECV may be offered from 36+0 wks.

Question 6

What are the contraindications to ECV?

Answer 6

• no general consensus on eligibility for, or contraindications to, ECV.
• ECV after one CS delivery appears to have no greater
  risk than with an unscarred uterus.

Question 7

What are the risks of ECV?

Answer 7

Women should be counselled that with appropriate precautions, ECV has a very low complication rate.

Question 8

What measures are appropriate to ensure fetal safety?

Answer 8

• ECV should be performed where facilities for monitoring and surgical delivery are available.
• standard preoperative preparations for caesarean section are not recommended for undergoing ECV.
• Following ECV, EFM is recommended.
• undergoing ECV, D negative: testing for fetomaternal
  haemorrhage and be offered anti-D.

Question 9

Who should perform ECV?

Answer 9

ECV should only be performed by a trained practitioner or by a trainee working under direct supervision.

Question 10

How acceptable is ECV to women?

Answer 10

Although most women tolerate ECV, they should be informed that ECV can be a painful procedure.

Question 11

How could the uptake of ECV be increased?

Answer 11

The uptake of ECV is best increased by timely identification of the baby presenting by breech and provision of evidence-based information

Question 12

How can an ECV service be developed and audited?

Answer 12

There is no evidence to support any particular service model although larger institutions may consider a dedicated ECV clinic.

Question 13

What is the role of non-ECV methods?

Answer 13

• may consider the use of moxibustion for breech presentation at 33–35 wks, under guidance of a trained practitioner.
• no evidence that postural management alone promotes spontaneous version to cephalic presentation.