External cephalic version: a review of the literature

Authors

  • Marta Orlovic Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Ana Marija Krznaric Lovosevic Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Maja Brkic Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Kosjenka Dermit Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Tihana Galic Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Ivona Plese Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Vladimir Blagaic Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb

DOI:

https://doi.org/10.5281/zenodo.1219210

Keywords:

breech presentation, cesarean section rate, external cephalic version, tocolysis

Abstract

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.

References

1. Hofmeyr GJ, Kulier R. External Cephalic Version for Breech Presentation at Term. Cochrane Database Syst Rev. 2000;2:CD000083. doi: 10.1002/14651858.CD000083.
2. Caukwell S, Joels LA, Kyle PM, Mills MS. Women's attitudes towards management of breech presentation at term. J Obstet Gynaecol. 2002;22(5):486-488. doi: 10.1080/0144361021000003591.
3. Leung TY, Lau TK, Lo KW, Rogers MS. A survey of pregnant women's attitude towards breech delivery and external cephalic version. Aust NZ J Obstet Gynaecol. 2000;40(3):253-259.
4. Raynes-Greenow CH, Roberts CL, Barratt A, Brodrick B, Peat B. Pregnant women's preferences and knowledge of term breech management, in an Australian setting. Midwifery. 2004;20(2):181-187. doi: 10.1016/j.midw.2003.10.002.
5. Westgren M, Edvall H, Nordström L, Svalenius E, Ranstam J. Spontaneous cephalic version of breech presentation in the last trimester. Br J Obstet Gynaecol. 1985;92(1):19-22.
6. Fianu S, Václavínková V. The site of placental attachment as a factor in the aetiology of breech presentation. Acta Obstet Gynecol Scand. 1978;57(4):371-372.
7. Ben-Rafael Z, Seidman DS, Recabi K, Bider D, Mashiach S. Uterine anomalies. A retrospective, matched-control study. J Reprod Med. 1991;36(10):723-727.
8. Michalas SP. Outcome of pregnancy in women with uterine malformation: evaluation of 62 cases. Int J Gynaecol Obstet. 1991;35(3):215-219.
9. Ranney B. The gentle art of external cephalic version. Am J Obstet Gynecol. 1973;116(2):239-251.
10. Kok M, van der Steeg JW, van der Post JA, Mol BW. Prediction of success of external cephalic version after 36 weeks. Am J Perinatol. 2011;28(2):103-110. doi: 10.1055/s-0030-1262909.
11. Ferguson JE 2nd, Armstrong MA, Dyson DC. Maternal and fetal factors affecting success of antepartum external cephalic version. Obstet Gynecol. 1987;70(5):722-725.
12. Kok M, Cnossen J, Gravendeel L, Van Der Post JA, Mol BW. Ultrasound factors to predict the outcome of external cephalic version: a meta-analysis. Ultrasound Obstet Gynecol. 2009;33(1):76-84. doi: 10.1002/uog.6277.
13. Burgos J, Cobos P, Rodríguez L, Osuna C, Centeno M, Martínez-Astorquiza T. Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. BJOG. 2014;121(2):230-235. doi: 10.1111/1471-0528.12487.
14. Kok M, Cnossen J, Gravendeel L, van der Post J, Opmeer B, Mol BW. Clinical factors to predict the outcome of external cephalic version: a metaanalysis. Am J Obstet Gynecol. 2008;199(6):630. doi: 10.1016/j.ajog.2008.03.008.
15. Nassar N, Roberts CL, Barratt A, Bell JC, Olive EC, Peat B. Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term. Paediatr Perinat Epidemiol. 2006;20(2):163-171. doi: 10.1111/j.1365-3016.2006.00702.x.
16. Collins S, Ellaway P, Harrington D, Pandit M, Impey LW. The complications of external cephalic version: results from 805 consecutive attempts. BJOG. 2007;114(5):636-638. doi: 10.1111/j.1471-0528.2007.01271.x.
17. Hofmeyr GJ. Effect of external cephalic version in late pregnancy on breech presentation and caesarean section rate: a controlled trial. Br J Obstet Gynaecol. 1983;90:392.
18. Karantanis E, Alcock D, Phelan LK, Homer CS, Davis GK. Introducing external cephalic version to clinical practice. Aust N Z J Obstet Gynaecol. 2001;41:395–397.
19. Kilpatrick SJ, Safford KL. Repeat external cephalic version. Is it worth the effort? J Reprod Med. 1995;40:775–778.
20. Fernandez CO, Bloom SL, Smulian JC, Ananth CV, Wendel GD Jr. A randomized placebo-controlled evaluation of terbutaline for external cephalic version. Obstet Gynecol. 1997;90(5):775-779.
21. Goetzinger KR, Harper LM, Tuuli MG, Macones GA, Colditz GA. Effect of regional anesthesia on the success rate of external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2011;118(5):1137-1144. doi: 10.1097/AOG.0b013e3182324583.
22. Johnson RL, Elliott JP. Fetal acoustic stimulation, an adjunct to external cephalic version: a blinded, randomized crossover study. Am J Obstet Gynecol. 1995;173:1369.

Downloads

Published

2017-09-30

How to Cite

Orlovic, M., Krznaric Lovosevic, A. M., Brkic, M., Dermit, K., Galic, T., Plese, I., & Blagaic, V. (2017). External cephalic version: a review of the literature. BioMedicine and Surgery, 1(3), 133–137. https://doi.org/10.5281/zenodo.1219210

Issue

Vol. 1 No. 3 (2017)

Section

Review

License

Articles in BioMedicine and Surgery are published under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license. Full text of Attribution-NonCommercial-NoDerivatives 4.0 International license can be viewed at https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode.