External Cephalic Version

Breech presentation occurs in 3% to 4% of all singleton pregnancies at term.1 Historically, management options for the term breech patient have been breech vaginal delivery, external cephalic version (ECV) and cesarean delivery. Since publication of the Term Breech Trial in 2000,2 there has been a shift away from vaginal breech delivery and an increase in rates of cesarean delivery.3 Since then, long-term outcomes after 2-year follow-up from that cohort did not show a difference in death or neurodevelopmental delay,4 but other cohorts have shown an increase in neonatal death or morbidity associated with vaginal breech delivery.5 Vaginal breech can be offered in selected cases, but because of limited training and experience, cesarean delivery rates will likely continue to be the predominant mode of delivery for this group of patients. Alternatively, ECV should be considered as patients approach term to decrease the rate of cesarean delivery. Incorporating ECV into routine practice may produce a decrease in morbidity and also has the potential to decrease health care costs.6 Success rates for the procedure range from 30% to 86%, with an average success rate of 58%.7 Despite the likely benefits afforded by ECV, the procedure is not routinely considered, thus resulting in a gap between present and ideal practice. Given the potential value and the wide range of success rates as described, a thorough understanding of patient selection and ECV techniques would be helpful to practicing obstetrician/gynecologists. The goal of this article is to provide a review of ECV to improve vaginal delivery rates and help guide the clinician in counseling patients about version.