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Updated: Nov 22, 2025

External Cephalic Version: Is it an Effective and Safe Procedure?
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Association of Persistent Breech Presentation With External Cephalic Version Success.

Roy Lauterbach1, Gal Bachar, Chen Ben-David

  • 1Department of Obstetrics and Gynecology, Rambam Health Care Campus, and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Obstetrics and Gynecology
|January 8, 2021
PubMed
Summary

Persistent breech presentation significantly reduces external cephalic version (ECV) success rates. Women with persistent breech presentation also face lower rates of vaginal delivery and higher rates of cesarean delivery after ECV.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine

Background:

  • Breech presentation complicates delivery, often necessitating interventions.
  • External cephalic version (ECV) is a procedure to turn a fetus from breech to cephalic presentation.
  • Persistent breech presentation, defined as breech throughout pregnancy, is a less-studied factor in ECV outcomes.

Purpose of the Study:

  • To investigate the correlation between persistent breech presentation and the success rate of external cephalic version (ECV).
  • To analyze the impact of persistent breech presentation on delivery mode following successful ECV.

Main Methods:

  • Retrospective study of 1,271 women undergoing ECV from 2008-2019.
  • Persistent breech presentation defined by lack of cephalic presentation on ultrasounds from mid-pregnancy to ECV.
  • Primary outcome: ECV success rate. Secondary outcome: mode of delivery.

Main Results:

  • ECV was attempted in 684 women (53.8%) with an overall success rate of 61.5%.
  • ECV success was significantly lower in persistent breech presentation (19.6%) compared to non-persistent (82.0%).
  • Women with persistent breech presentation had lower vaginal delivery rates (27.3% vs 79%) and higher cesarean delivery rates (43% vs 7%) after successful ECV.

Conclusions:

  • Persistent breech presentation is associated with a high failure rate for ECV.
  • Women with persistent breech presentation experience significantly lower rates of spontaneous vaginal delivery.
  • The findings highlight the challenges and altered delivery outcomes for persistent breech presentation.