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Updated: Apr 23, 2026
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External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
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Implementation of external cephalic version in the Netherlands: a retrospective cohort study
Floortje Vlemmix1, Ageeth N Rosman, Susan te Hoven
1Department of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, the Netherlands.
Birth (Berkeley, Calif.)
|October 8, 2014
Summary
External cephalic version (ECV) rates vary significantly across Dutch hospitals. Suboptimal implementation is primarily due to healthcare providers not offering ECV, and secondarily due to patient choice.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Healthcare Implementation Science
Background:
- External cephalic version (ECV) is crucial for reducing cesarean sections in breech presentations.
- However, studies indicate that not all eligible women receive an ECV attempt.
- Understanding implementation variations is key to improving access.
Purpose of the Study:
- To evaluate the implementation rates of ECV in the Netherlands.
- To identify hospital characteristics and individual factors influencing ECV uptake.
- To analyze reasons for suboptimal ECV implementation.
Main Methods:
- Retrospective cohort study involving 40 Dutch hospitals.
- Reviewed charts of 4,770 women with singleton breech deliveries from 36 weeks gestation (2008-2009).
- Documented ECV attempts, reasons for non-performance, delivery mode, and hospital characteristics.
Main Results:
- ECV was performed in 62.2% of eligible women across 36 participating hospitals (range 8.2-83.6%).
- Higher ECV rates were observed in teaching hospitals, those with dedicated ECV hours, larger units, and urban locations.
- Suboptimal implementation was mainly attributed to healthcare providers not offering ECV.
Conclusions:
- Significant variation exists in ECV implementation rates among Dutch hospitals.
- The primary barrier to ECV is providers not offering the procedure, followed by patient refusal.
- A thorough understanding of these barriers is essential for developing effective implementation strategies.
