External cephalic version without tocolysis

The increased rate of cesarean section in the United States is in part the result of more liberal use of the operation because of breech presentation. In an attempt to reduce the incidence of breech presentation in labor in a group of private patients, 66 patients underwent 90 attempted external cephalic versions in my office without tocolysis. The success rate of external cephalic version at or before 34 weeks was 74.3%, and only 45.5% after 34 weeks. The overall success rate was 60.6%. Subsequent attempts in five patients who had spontaneous reversion to breech were successful. No fetal or maternal mortality or morbidity occurred. One patient with Rh negative blood may have become isoimmunized as a result of version manipulation. Successful external cephalic version without tocolysis was accomplished with gentle, nonpersistent manipulation at or before 34 weeks.