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Controlled trial of external cephalic version.

J Kasule, T H Chimbira, I M Brown

British Journal of Obstetrics and Gynaecology

|January 1, 1985

Summary

External cephalic version (ECV) for breech presentations after 30 weeks gestation showed no significant benefits. This study suggests ECV is not recommended before 36 weeks gestation due to potential risks.

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Area of Science:

Obstetrics and Gynecology
Perinatal Medicine
Maternal-Fetal Medicine

Background:

Breech presentation complicates approximately 3-4% of term pregnancies.
External cephalic version (ECV) is a procedure to turn a fetus from breech to cephalic presentation before labor.
The optimal timing and efficacy of ECV remain subjects of ongoing research.

Purpose of the Study:

To evaluate the effectiveness and safety of external cephalic version (ECV) in singleton breech presentations after 30 weeks gestation.
To compare outcomes between patients undergoing ECV and a control group without attempted version.
To determine the optimal gestational age for performing ECV.

Main Methods:

A prospective randomized controlled trial was conducted with 640 singleton breech presentations after 30 weeks gestation.
Patients were randomized into two groups: attempted external cephalic version (n=310) and a control group (n=330).
Outcomes assessed included vaginal breech delivery rates, cesarean section rates, and perinatal mortality and morbidity.

Main Results:

Three perinatal deaths were directly attributed to the external cephalic version procedure.
No statistically significant differences were observed in vaginal breech delivery rates, cesarean section rates, or perinatal mortality and morbidity between the ECV and control groups.
The incidence of adverse events was low but present in the ECV group.

Conclusions:

External cephalic version attempted before 36 weeks gestation in breech presentations did not improve key obstetric outcomes.
The findings suggest that external cephalic version is not indicated before 36 weeks gestation.
Further research may be needed to refine ECV protocols and patient selection criteria.

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