Fetal Scalp Fracture and External Cephalic Version
No, fetal scalp fracture is not a recognized complication of external cephalic version (ECV), though femoral fracture has been reported as a rare complication of the procedure.
Evidence from ECV Studies
The available evidence on ECV complications does not identify scalp fractures as an associated risk:
A large Italian study of 923 ECVs reported one case of femoral fracture attributable to the version procedure, but no skull or scalp fractures were documented 1.
Systematic reviews of ECV at term involving over 1,300 women found no significant differences in neonatal outcomes, including Apgar scores, umbilical cord pH, or perinatal death, with no mention of skull or scalp fractures as complications 2.
An 18-year cohort study of over 2,600 ECV attempts reported a corrected perinatal mortality of only 0.12% and described ECV as having a low complication rate, with no documentation of scalp fractures 3.
A 6-year study of 317 versions found complications to be "very few and mostly mild," with no skull or scalp fractures reported 4.
Distinction from Impacted Fetal Head at Cesarean Delivery
Skull fractures ARE recognized as a complication of impacted fetal head during cesarean delivery, not ECV:
The American College of Obstetricians and Gynecologists recognizes skull fractures as potential neonatal consequences of impacted fetal head at cesarean delivery, along with brain hemorrhage and hypoxic brain injury 5.
Perinatal skull fractures have been associated with the vaginal "push" technique used during cesarean delivery for impacted fetal head, though digital pressure on the vertex is unlikely to directly cause parietal fractures 5.
Clinical Pitfall to Avoid
Do not confuse complications of ECV with complications of impacted fetal head management during cesarean delivery. These are entirely different procedures occurring in different clinical contexts—ECV is an external manipulation performed before labor to rotate a breech fetus, while impacted fetal head management involves maneuvers during cesarean delivery when the fetal head is wedged deep in the pelvis 5.