External Cephalic Version: Clinical Recommendations and Factors for Success
Breech occurs in approximately 3 to 4% of term pregnancies. The goal of External Cephalic Version (ECV) is to increase the proportion of vertex presentation at term and to decrease the risk of cesarean delivery secondary to breech presentation. Between 20 to 30% of eligible women are not offered this procedure
Fetal presentation should be assessed beginning at 36w0d
Preterm ECV has been linked with higher rates of initial success, but increased risk of preterm birth and higher rates of reversion
If spontaneous version is going to occur it is likely to have occurred by then
Risk of spontaneous reversion is decreased
ECV during delivery admission vs breech presentation has a 65% success rate and is associated with
Lower cesarean delivery rate
Lower likelihood of hospital stay >7 days
Limited information in women with preexisting uterine scar or during early stages of labor
ECV is contraindicated when vaginal delivery is not clinically appropriate
There are no absolute or relative contraindications
Evaluate each case individually
Fewer cesarean deliveries
Lower odds of
Endometritis | Sepsis | Hospital stay > 7 days
Lower hospital charges
No differences for
Low Apgar | Low umbilical vein pH | Neonatal death
Risks and Adverse effects
Most common risk is fetal heart rate changes
Typically, heart rate stabilizes when procedure is discontinued
Overall serious adverse effects are very low with rates <1%
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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