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Info Sheet: External Cephalic Version

Posted on March 14, 2014 at 5:26 AM
External Cephalic Version for Breech Position
 
*Definition of the procedure/test
External cephalic version, or version, is a procedure used to turn a fetus from a breech position or side-lying (transverse) position into a head-down (vertex) position before labor begins. Your [practitioner] will use his or her hands on the outside of your abdomen to try to turn the baby
Source ~ Quoted from: 
http://www.webmd.com/baby/external-cephalic-version-version-for-breech-position
           
Image Source: 
Scott & White Healthcare http://bit.ly/1eyZCgI
 
*History
External version has apparently been practiced since the time of Aristotle (384 to 322 B.C.), who stated that many of his fellow authors advised midwives who were confronted with a breech presentation to “change the figure and place the head so that it may present at birth.” However, external version eventually fell out of favor as a result of several concerns: its high rate of spontaneous reversion (turning back to breech presentation) if performed before 36 weeks of gestation, possible fetal complications, and the assumption that an external version converts only those fetuses to vertex that would have converted spontaneously anyway.
 
Studies have documented the success and safety of external version. The authors of a recent literature review of 25 studies on the efficacy of external cephalic version calculated an overall success rate of 63.3 percent, with a range of 48 to 77 percent. Most of these studies used the currently accepted protocol that is discussed in this article. These studies documented minimal risks, including umbilical cord entanglement, abruptio placentae, preterm labor, premature rupture of the membranes (PROM) and severe maternal discomfort. Overall complication rates have ranged from about 1 to 2 percent since 1979. In another study, fetal heart rate changes occurred in 39 percent of fetuses during external version attempts, but these changes were transient and had no relationship to the final outcome. Importantly, the literature provides overwhelmingly reassuring evidence regarding the risk of fetal death. Before 1980, four fetal deaths from external cephalic version had been reported. All of these deaths occurred in association with attempts at external version using general anesthesia. Since 1980, only two fetal deaths have been reported with external version. Both occurred without the use of fetal heart rate monitoring or ultrasonography in preterm infants in Zimbabwe.

A recent study reported a success rate for external cephalic version of 69.5 percent. Noteworthy was the fact that among fetuses undergoing successful version, the incidence of intrapartum cesarean section was 16.9 percent, a figure that was 2.25 times higher than that in the control group. The high rate of cesarean delivery resulted from a significantly higher incidence of fetal distress and labor dystocia in the group receiving external version. Results of this study demonstrate that even after successful version, a higher rate of intrapartum abnormalities may occur.
Source: Quoted from American Academy of Family Physicians 


Image Source:
WHO Health Education To Villages http://bit.ly/1eyZWfv
 
*PROS
  • External version success rate is 63% at term (37 weeks or more gestation)
  • Researchers have found that having an external cephalic version decreased the risk of breech birth by 54% and decreased the risk of C-section by 33%
  • If a baby is in the “complete breech” position (buttocks down, with the legs folded at the knees and the feet near the buttocks) this increases the chance that the version will be successful.
  • Version is also more likely to be successful if the placenta is posterior (on the back side of the uterus) and if there are normal levels of amniotic fluid (an Amniotic Fluid Index >10)
  • The most common risk is a temporary change in the infant’s heart rate (4.7%); serious complications are rare (0.24%)
Sources ~ Quoted from: 
 
 
*CONS
Potential Risks include:
  • Twisting or squeezing of the umbilical cord, reducing blood flow and oxygen to the fetus.
  • The beginning of labor, which can be caused by rupture of the amniotic sac around the fetus (premature rupture of the membranes, or PROM).
  • Placentae abruptio, rupture of the uterus, or damage to the umbilical cord. The potential exists for such complications, but they are very rare.
  • 1 urgent C-section for every 286 versions. Recommended that a version should take place in a setting where an urgent C-section could be performed if necessary.
Sources ~ Quoted from:
  

Links with other options to explore 
 

Alternatives for turning breech babies


Categories: ECV, External Cephalic Version, Info Sheet, Information Sheet

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