From the Research
External Cephalic Version (ECV) should be performed by obtaining informed consent, confirming fetal position via ultrasound, and administering tocolytic medication such as terbutaline (0.25 mg subcutaneously) or nifedipine (10-20 mg orally) to relax the uterus, with a success rate of approximately 50-70%. The procedure begins with pre-procedure preparation, including:
- Maternal blood typing
- Fetal monitoring
- Administration of tocolytic medication to relax the uterus
- The patient should have an empty bladder and lie in a supine position with slight left lateral tilt to prevent vena cava compression. The provider applies ultrasound gel to the abdomen, then uses both hands to gently manipulate the fetus, with one hand lifting the breech out of the pelvis while the other guides the fetal head downward. The forward roll technique (moving the fetus in a forward somersault) is most commonly used, though a backward flip may be attempted if the forward approach fails. Continuous fetal heart rate monitoring is essential throughout the procedure, which should be immediately stopped if there are signs of fetal distress, excessive maternal discomfort, or after 3-4 unsuccessful attempts. Following the procedure, the fetus should be monitored for at least 30 minutes, and Rh-negative mothers should receive Rh immunoglobulin (RhoGAM) 1. ECV is typically performed at 36-38 weeks gestation when there is sufficient amniotic fluid but before the fetus becomes too large, and has been shown to be effective in reducing the number of cesarean sections for breech presentations, with a success rate of 66.1% in one study 2. Factors associated with successful ECV include previous vaginal delivery and maternal Body Mass Index (BMI), with patients with a BMI > 40 kg/m2 having a lower success rate 3. Overall, ECV is a safe and effective procedure that can be used to reduce the risk of cesarean delivery and improve outcomes for women with breech presentations.