External cephalic version - NYSORA

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Contributors

External cephalic version

External cephalic version

Learning objectives

  • Definition of external cephalic version (ECV)
  • Procedure to perform ECV

Definition and mechanisms

  • Is a procedure to change the presentation of the fetus from breech, transverse, or oblique to vertex by applying pressure externally to the fetus through the gravid abdomen in order to enable vaginal delivery
    • In contrast to the internal cephalic version, in which a hand is inserted through the cervix to turn the baby
  • About 3% of the babies are in a breech position after 36 weeks of pregnancy
  • Typically performed around 37 weeks but can even be performed in early labor
  • The procedure is done externally by applying firm pressure to your abdomen
  • This pressure lasts several minutes and can cause the uterus to cramp
  • The success rate is about 58%, tends to be the best at 37 weeks, and depends on:
    • Practitioner experience
    • Maternal weight
    • Uterine relaxation
    • A palpable fetal head
    • A non-engaged breech
    • Non-anterior placenta
    • An amniotic fluid index above 7-10 cm
  • Only a small chance (5%) that the baby will turn spontaneously to breech again
Factors that may increase the successFactors associated with a decreased success
Multiparity 
Transverse or oblique presentation
Complete breech
Adequate amniotic fluid
Nulliparity
Advanced dilation
Estimated fetal weight < 2500 g
Anterior, lateral, or cornual placenta
Decreased amniotic fluid or rupture of membranes
Maternal obesity
Frank breech
Fetal spine in the posterior position

Contraindications

Complications

Management

External cephalic version, rh status, breech position, cardiotocography, C-section, tocolytic agents, terbutaline, remifentanil, anti-D immune glubulin

Suggested reading

  • Weiniger, C.F., Rabkin, V., 2020. Neuraxial block and success of external cephalic version. BJA Education 20, 296–297.
  • Weiniger CF. Analgesia/anesthesia for external cephalic version. Curr Opin Anaesthesiol. 2013;26(3):278-287.
  • Rosman AN, Guijt A, Vlemmix F, Rijnders M, Mol BW, Kok M. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand. 2013;92(2):137-142.

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