Introducing routine external cephalic version for the management of the malpresenting fetus near term

Abstract

Background: The aim of this study was to assess the efficacy and safety of external cephalic version (ECV) when its use was introduced in the routine management of breech presentation and transverse lie after 36 weeks by obstetricians with limited prior experience with the procedure. The influence of various factors on the outcome of ECV was also studied.

Methods: Retrospective study of 44 consecutive cases of ECV which were analysed with respect to outcome, parity, type of breech, placental site and birth weight.

Results: ECV was successful in 45% of women, 80% of women with successful ECV delivered vaginally while 10% underwent spontaneous reversion to a non-cephalic presentation. In contrast, only 15% of women with failed ECV delivered vaginally. Parity, type of breech presentation and placental location did not significantly affect the outcome of ECV although there was a trend towards better success rate of ECV with multiparity, flexed breech presentation, transverse lie and posteriorly-located placentae. The mean birth weight of fetuses of women with successful ECV was significantly heavier than those of women who failed ECV (p < 0.001). No significant fetal or maternal morbidity occurred as a result of ECV in this study.

Conclusion: ECV is a safe and effective procedure that is useful in the management of breech presentation and transverse lie near term. The lack of prior experience with the procedure does not appear to influence the success rate or morbidity.