From the Research
External cephalic version (ECV) is a relatively safe and effective procedure for turning a breech baby to head-down position before delivery, with benefits generally outweighing risks for most women, including those with a previous caesarean delivery, as evidenced by a systematic review published in 2021 1. The main benefit of ECV is avoiding a cesarean section, as it has a 50-100% success rate in turning the baby, allowing for a safer vaginal delivery. Some of the key points to consider when evaluating the risk-benefit of ECV include:
- ECV success rates and subsequent vaginal delivery rates ranged from 50 to 100% and from 50 to 74.9%, respectively, in women with a previous caesarean delivery 1
- ECV complications reported included abnormal fetal heart rate, abnormal cardiotocography, and transient vaginal bleeding, but no cases of uterine rupture were reported 1
- A previous vaginal delivery increases the success rate of ECV, while a high maternal Body Mass Index (BMI) affects the success of ECV 2
- ECV is an effective procedure to reduce the number of cesarean sections for breech presentations, with a success rate of 82.5% in one study 2
- The procedure should be performed in a setting where emergency cesarean delivery is available if needed, and patients should receive a non-stress test and ultrasound to confirm fetal position and well-being before ECV
- Tocolytic medications like terbutaline or nifedipine may be used to relax the uterus and improve success rates, but the decision to use these medications should be made on a case-by-case basis
- ECV is contraindicated in cases of multiple gestation, abnormal fetal heart patterns, placenta previa, previous uterine surgery, or oligohydramnios, and the procedure's safety and effectiveness make it a valuable option for managing breech presentations before resorting to cesarean delivery.