Exxcellence pearls: malpresentation, breach and external cephalic version

Question 0

What is the success rate for external cephalic version?

What risks should be discussed?

Answer 0

35-86% with average being 58%.

Rates of reversion, fetal distress that could lead to hospital admission for observation, emergency cesarean, or fetal death.

Question 1

What percentage of fetuses are breech at 37 weeks?

Beyond 40 weeks?

Answer 1

Less than 5%

Less than 2%

Question 2

What are contraindications to external version?

Answer 2

Breech firmly fixed in the pelvis, marked oligohydramnios, previa, third trimester bleeding, prior uterine surgery except TOLAC, fetal distress

Question 3

Describe the protocol for external version.

Answer 3

1. OR on standby
2. Reactive NST
3. Assess if breach is out of the pelvis and for contractile reactivity
4. forward or backflip
5. Assess fetal heart rate when transverse or ultrasound throughout
6. NST to follow
7. RhoGAM if Rh negative

Question 4

What criteria are necessary for considering a planned breech vaginal delivery?

Answer 4

37 weeks or older, EFW between 2500-4000 g, frank or complete breech presentation, no fetal anomalies, AFI normal, fetal neck should not be hyperextended, labor should not be induced or augmented except AROM, continuous EFM and close labor monitoring.