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The introduction of external cephalic version at term into routine clinical practice
S Bewley1, S C Robson, M Smith
1Department of Obstetrics and Gynaecology, University College and Middlesex School of Medicine, London, UK.
European Journal of Obstetrics, Gynecology, and Reproductive Biology
|December 15, 1993
Summary
External cephalic version (ECV) for breech presentation at term is a safe management option. While its overall impact is limited, ECV can help avoid some vaginal breech deliveries and cesarean sections.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Breech presentation complicates approximately 3-5% of term pregnancies.
- External cephalic version (ECV) is a procedure to turn a fetus from breech to cephalic presentation before labor.
- ECV aims to reduce the rate of cesarean deliveries for breech presentation.
Purpose of the Study:
- To evaluate the safety and effectiveness of introducing ECV as a management option for term breech presentation.
- To audit the implementation of an ECV policy in a university teaching hospital.
Main Methods:
- Prospective data collection of women offered ECV at term (≥37 weeks' gestation).
- Retrospective review of all breech deliveries during the study period.
- Analysis of ECV success rates and reasons for not offering ECV.
Main Results:
- ECV was attempted in 52 women with an immediate success rate of 46%.
- Spontaneous version occurred in 4 additional cases before ECV.
- Of 72 breech deliveries, 49 were known breech and not offered ECV; 39 had no contraindication (28% failure to offer ECV).
- 22 breech presentations (18%) were undiagnosed until labor.
Conclusions:
- ECV at term can be safely introduced with a strict protocol.
- While the overall clinical impact may be limited, ECV is a useful addition to antenatal management for selected women with breech presentation.
- ECV can potentially reduce the number of vaginal breech deliveries and cesarean sections.