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Updated: Aug 9, 2025
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External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
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The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study
Offra Engel1,2, Shmuel Arnon2,3, Gil Shechter Maor1,3,4
1Obstetrical & Gynecological Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel.
Children (Basel, Switzerland)
|February 25, 2023
Summary
External cephalic version (ECV) for breech presentation is safe and effective. Umbilical artery Doppler indices temporarily change post-ECV, indicating transient placental perfusion alterations without adverse fetal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Maternal-Fetal Medicine
Background:
- External cephalic version (ECV) is a primary intervention for term breech presentation.
- Fetal well-being post-ECV is typically assessed using non-stress tests (NST).
- Doppler velocimetry offers an alternative for monitoring fetal compromise.
Purpose of the Study:
- To evaluate changes in umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) Doppler indices before and after ECV.
- To assess the safety and impact of ECV on fetal circulation using Doppler velocimetry.
- To determine if ECV causes significant or lasting alterations in placental perfusion.
Main Methods:
- Prospective study of 56 uncomplicated term breech pregnancies undergoing elective ECV.
- Doppler velocimetry of UA, MCA, and DV performed within 1 hour before and 2 hours after ECV.
- Comparison of Doppler indices (S/D ratio, PI, RI) pre- and post-procedure.
Main Results:
- ECV success rate was 75%.
- Significant increases observed in UA S/D ratio (p=0.021), UA pulsatility index (PI) (p=0.042), and UA resistance index (RI) (p=0.022) post-ECV.
- No significant changes noted in MCA or DV Doppler indices before and after ECV.
- All patients were discharged without complications.
Conclusions:
- ECV is a safe procedure for term breech presentation.
- Transient changes in UA Doppler indices post-ECV suggest temporary placental perfusion interference.
- These Doppler alterations are likely short-term and do not negatively impact uncomplicated pregnancies.
- Careful patient selection for ECV remains crucial due to its potential as a physiological stressor.
