External cephalic version

Abstract

Breech presentation occurs in approximately 3–4% of term pregnancies (1), and there is a high cesarean delivery rate for breech presentation (2). External cephalic version provides a means of reducing cesarean deliveries, but implementation of ECV varies, with an estimated 20–30% of eligible women not being offered ECV (3, 4). External cephalic version involves applying pressure to a woman’s abdomen to turn the fetus in either a forward or backward roll to achieve a vertex presentation. The goal of ECV is to increase the proportion of vertex presentations among fetuses that were formerly in the breech position near term. Once a vertex presentation is achieved, the chances for a vaginal delivery increase. If an ECV attempt is not successful and breech presentation persists, the decision regarding mode of delivery should depend on the expertise of the health care provider. Thus, a planned term singleton breech vaginal delivery may be reasonable in some cases with full patient counseling and consent, and following specific management protocols (5). Clinical Considerations and Recommendations