External cephalic version: a review of the literature
External cephalic version (ECV) is a manipulation of the fetus through mother's abdomen in which the baby is rotated from the breech to the cephalic presentation in order to reduce the incidence of caesarean sections indicated by pelvic presentation, what would by far reduce the incidence of postpartum maternity morbidity. External cephalic version does not change the Apgar scores of the babies, pH levels in the umbilical cord, the percentage of babies admitted to the intensive care unit, perinatal mortality, or the duration of delivery. Incidence of pelvic presentation is 3-4% of all term pregnancies. Breech position is the third most frequent indication for cesarean section, repeat cesarean section and labor dystocia. According to recommendations from ACOG, Royal College of Obstetricians and Gynecologists, the Dutch Society for Obstetrics and Gynecology and Royal Dutch Organization for midwifes, external cephalic version should be available and offered to all women with near term pregnancies and a breech position, if there are no contraindications for the procedure. For pregnant women who meet certain conditions ECV is considered to be safe and effective procedure for rotating the fetus to the cephalic presentation, in order to increase the probability of cephalic vaginal delivery. Studies show that after ECV the risk of breech delivery is reduced by 54%, and the risk of cesarean delivery is reduced by 33%. Although ECV decreases the incidence of cesarean deliveries, the cesarean delivery after ECV is still higher than in the general population, being contributed to both dystocia and non-reassuring cardiotocography CTG patterns as indications for the cesarean section.
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