External Cephalic Version

External Cephalic Version involves applying pressure to a woman’s abdomen to manipulate the fetus and turn it from breech to vertex presentation, which increases the likelihood of a vaginal delivery. Interest in the technique has increased in light of medicine’s movement to decrease caesarean deliveries, which particularly in North America has been standard procedure for breech presentations.
The American College of Obstetricians and Gynecologists (ACOG) now recommends that all eligible women with breech presentations who are near term should be offered external cephalic version (ECV) to cut down on the number of caesarean deliveries. It is a valuable management technique and, in a properly selected population, poses little risk to either the woman or the fetus. If successful, ECV provides a clear benefit to the woman by allowing her an opportunity for a successful vertex vaginal delivery. Obstet Gynecol. 2016;127:412-413
Spontaneous version of a breech presentation usually occurs by 36 weeks and is less likely after that time.
How effective is ECV in preventing non-cephalic birth?
• The success rate of ECV is approximately 50%.
• A successful ECV reduces the chance of caesarean section.
• Few babies revert to breech after successful ECV.
• After an unsuccessful ECV attempt at 36 weeks of gestation or later, only a few babies presenting by the breech will spontaneously turn to cephalic presentation.

Potential complications
There is no general consensus on the eligibility for, or contraindications to, ECV.
ECV after one caesarean delivery appears to have no greater risk than with an unscarred uterus.
Although case reports of placental abruption and large feto-maternal haemorrhage exist, complications associated with ECV are very rare. In a 2015 Cochrane systematic review, Hofmeyr et al.reported no significant differences in Apgar scores, neonatal admission or perinatal death according to whether ECV had been performed or not. A number of large consecutive series have reported no fetal deaths attributable to the procedure.
The reported risk of emergency caesarean section within 24 hours is approximately 0.5%, with the indication in over 90% being vaginal bleeding or an abnormal CTG following the procedure
If, after ECV, the breech persists, the best mode of delivery should depend on expertise of the healthcare provider.
Royal College of Obstetricians and Gynaecologists. Management of Breech Presentation. Green-top Guideline No. 20b. London: RCOG; 2017.
• Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2015;(4):
• Tong Leung VK, Suen SS, Singh Sahota D, Lau TK, Yeung Leung T. External cephalic version does not increase the risk of intra-uterine death: a 17-year experience and literature review. J Matern Fetal Neonatal Med 2012;25:1774–8.
• Collins S, Ellaway P, Harrington D, Pandit M, Impey LW. The complications of external cephalic version: results from 805 consecutive attempts. BJOG 2007;114:636–8
• Leung TY, Lau TK. Prediction of outcome of external cephalic version for breech presentation at term. Fetal Matern Med Rev 2005;16:245–62.
• Burgos J, Cobos P, Rodrıguez L, Osuna C, Centeno MM, , et al. Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study BJOG 2014;121:230–5; discussion 235.
• Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev 2012;(5):

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