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Related Experiment Videos

External cephalic version beginning at 34 weeks' gestation versus 37 weeks' gestation: a randomized multicenter

Eileen K Hutton1, Karyn Kaufman, Ellen Hodnett

  • 1Department of Family Medicine (Midwifery), Faculty of Health Sciences, McMaster University, Ontario, Canada. eileen.hutton@utoronto.ca

American Journal of Obstetrics and Gynecology
|July 16, 2003
PubMed
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External cephalic version (ECV) performed earlier, between 34-36 weeks, may reduce noncephalic births compared to later ECV. Further trials are needed to confirm benefits for cesarean rates and neonatal outcomes.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatal Research

Background:

  • Noncephalic fetal presentation occurs in 3-4% of term pregnancies.
  • External cephalic version (ECV) can reduce noncephalic births and cesarean sections but has low success rates.
  • Optimizing the timing of ECV may improve outcomes.

Purpose of the Study:

  • To compare the effectiveness of early ECV (34-36 weeks) versus delayed ECV (37-38 weeks) in reducing noncephalic presentation at birth.
  • To assess the impact of early ECV on cesarean section rates and neonatal outcomes.

Main Methods:

  • A randomized trial involving 233 women with singleton breech fetuses across 25 centers in seven countries.
  • Participants were assigned to either early ECV (34-36 weeks) or delayed ECV (37-38 weeks).

Related Experiment Videos

  • Procedures were performed by experienced practitioners, with repeat ECV, tocolytics, and epidural analgesia permitted; primary outcome was noncephalic presentation at birth.

    • Main Results:

    • The rate of noncephalic presentation at birth was 56.9% in the early ECV group versus 66.4% in the delayed ECV group (RR 0.86 [0.70-1.05], P=.09).
    • Serious fetal complications and preterm birth rates (<37 weeks) were not significantly increased with early ECV.
    • Cesarean section rates were 64.7% for early ECV and 71.6% for delayed ECV (RR 0.90 [0.76-1.08], P=.32), with comparable neonatal outcomes.

    Conclusions:

    • Early ECV at 34-36 weeks gestation may potentially reduce the risk of noncephalic presentation at delivery compared to ECV at 37-38 weeks.
    • A large pragmatic trial is warranted to further evaluate early ECV's impact on cesarean rates and neonatal outcomes before clinical practice changes.