External cephalic version

Learning objectives

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 success	Factors 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