Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Apr;118(5):564-77.
doi: 10.1111/j.1471-0528.2010.02837.x. Epub 2011 Feb 4.

The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies

E K Hutton  1 , M E Hannah, S J Ross, M-F Delisle, G D Carson, R Windrim, A Ohlsson, A R Willan, A Gafni, G Sylvestre, R Natale, Y Barrett, J K Pollard, M S Dunn, P Turtle; Early ECV2 Trial Collaborative Group
Collaborators, Affiliations
Free PMC article
Randomized Controlled Trial

The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies

E K Hutton et al. BJOG. 2011 Apr.
Free PMC article

Abstract

Objective: To investigate whether initiating external cephalic version (ECV) earlier in pregnancy might increase the rate of successful ECV procedures, and be more effective in decreasing the rate of non-cephalic presentation at birth and of caesarean section.

Design: An unblinded multicentred randomised controlled trial.

Setting: A total of 1543 women were randomised from 68 centres in 21 countries.

Population: Women with a singleton breech fetus at a gestational age of 33(0/7) weeks (231 days) to 35(6/7) weeks (251 days) of gestation were included.

Methods: Participants were randomly assigned to having a first ECV procedure between the gestational ages of 34(0/7) (238 days) and 35(6/7) weeks of gestation (early ECV group) or at or after 37(0/7) (259 days) weeks of gestation (delayed ECV group).

Main outcome measures: The primary outcome was the rate of caesarean section; the secondary outcome was the rate of preterm birth.

Results: Fewer fetuses were in a non-cephalic presentation at birth in the early ECV group (314/765 [41.1%] versus 377/768 [49.1%] in the delayed ECV group; relative risk [RR] 0.84, 95% CI 0.75, 0.94, P=0.002). There were no differences in rates of caesarean section (398/765 [52.0%] versus 430/768 [56.0%]; RR 0.93, 95% CI 0.85, 1.02, P=0.12) or in risk of preterm birth (50/765 [6.5%] versus 34/768 [4.4%]; RR 1.48, 95% CI 0.97, 2.26, P=0.07) between groups.

Conclusion: External cephalic version at 34-35 weeks versus 37 or more weeks of gestation increases the likelihood of cephalic presentation at birth but does not reduce the rate of caesarean section and may increase the rate of preterm birth.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
Forest plot comparison: meta-analysis of caesarean section.
Figure 3
Figure 3
Forest plot comparison: meta-analysis of preterm birth <37 weeks of gestation.
See this image and copyright information in PMC

Comment in

References

    1. Hutton EK, Hannah ME, Barrett J. Use of external cephalic version for breech pregnancy and mode of delivery for breech and twin pregnancy: a survey of Canadian practitioners. J Obstet Gynaecol Can. 2002;24:804–10. - PubMed
    1. Goffinet F, Carayol M, Foidart JM, Alexander S, Uzan S, Subtil D, et al. for the PREMODA Study Group Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol. 2006;194:1002–11. - PubMed
    1. Hofmeyr GJ, Kulier R. External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2005 Issue 1. Art. No.: CD000083. DOI: 10.1002/14651858.CD000083. - DOI - PubMed
    1. Impey LWM, Hofmeyr GJ. External Cephalic Version and Reducing the Incidence of Breech Presentation. London: RCOG Press; 2006. Green Top Guidelines No.20a.
    1. American College of Obstetrics and Gynecology (ACOG) Clinical management guidelines for obstetrician–gynecologists: External Cephalic Version. ACOG Practice Bull. 2000;13:380–5. (reaffirmed 2009)

Publication types

Associated data