What is external cephalic version (ECV), when is it offered, and what features favour success?

ECV is manual turning of a breech to cephalic through the abdomen, offered from about 36-37 weeks (before labour) to enable vaginal cephalic birth.

Favourable features: a flexed (complete) breech, an unengaged breech, adequate liquor, a relaxed uterus (tocolysis may help), and multiparity. It is contraindicated where vaginal delivery is unsafe (e.g. praevia, recent APH, abnormal CTG, multiple pregnancy).

Clinical relevance. ECV at 36-37 weeks with favourable features avoids breech caesareans.

More Detail

External cephalic version

ECV reduces the number of breech presentations at term and the associated caesarean rate.

What and when

• Manual turning of a breech fetus to cephalic by abdominal manipulation.
• Offered from about 36-37 weeks in the antenatal setting, before labour (there may be a limited place in early labour). A transverse lie persisting in labour at term is best managed by caesarean, not ECV.

Favourable features for success

• Flexed (complete) breech.
• Unengaged breech (mobile presenting part).
• Adequate liquor volume and a relaxed uterus (tocolysis, e.g. a beta-agonist, can aid).
• Multiparity (lax abdominal/uterine wall).

Contraindications

Situations where vaginal birth would be unsafe or version risky: placenta praevia, recent antepartum haemorrhage, abnormal CTG, ruptured membranes/oligohydramnios, multiple pregnancy, uterine scar/abnormality. Anti-D is given to RhD-negative women after ECV.