External cephalic version for breech presentation before term

Management of breech presentation is controversial, both in regard to manipulation of the position of the fetus and the method of delivery. External cephalic version may reduce the number of breech presentations and caesarean sections, but there also have been reports of increased perinatal mortality with the procedure.

The objective of this review was to assess the effects of external cephalic version for breech presentation before term on measures of pregnancy outcome.

The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: October 1997.

Randomised and quasi-randomised trials of external cephalic version before term (37 weeks gestation) compared with a control group in women with breech presentation before term.

Eligibility and trial quality were assessed by the reviewer.

Three studies involving 889 women were included. There was no significant effect of external cephalic version before term on the following: non-cephalic presentation (relative risk 1.02, 95% confidence interval 0.89 to 1.17); caesarean section (relative risk 1.10, 95% confidence interval 0.78 to 1.54); low Apgar scores (relative risk 0.81, 95% confidence interval 0.44 to 1.49); perinatal mortality (relative risk 1.19, 95% confidence interval 0.46 to 3.05).

External cephalic version before term does not appear to improve pregnancy outcomes.