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
ACOG Practice Bulletin: External Cephalic Version
ACOG guidance addresses the trend in the United States to deliver term singleton fetuses in breech presentation by cesarean section and the concomitant decrease in the number of practitioners with the skills and experience to perform vaginal breech deliveries. In 2001, the ACOG committee on Obstetric Practice recommended that planned vaginal delivery of a singleton breech was no longer appropriate but due to additional publications since that time, the recommendations have been updated.
If vaginal breech delivery is planned, a detailed informed consent should be documented that include risks and benefits
Current evidence demonstrates short-term benefits in neonatal and maternal morbidity and mortality from planned cesarean delivery of the term fetus with a breech presentation. Long-term benefits of planned cesarean delivery for these infants and women are less clear.
The SOGC guidelines (2019; see ‘Learn More – Primary Sources’ below) address both oxytocin augmentation and induction as follows
Oxytocin augmentation is acceptable to correct weak uterine contractions. If progress in labour is poor despite adequate contractions, Caesarean section is recommended (strong recommendation; moderate quality evidence)
Although data are limited, induction of labour with breech presentation does not appear to be associated with poorer outcomes than spontaneous labour (weak recommendation; low quality evidence)
RCOG recommendations (2017; see Learn More – Primary Sources’ below) also address augmentation and induction and advises caution (D Grade Recommendation)
Women should be informed that induction of labour is not usually recommended.
Augmentation of slow progress with oxytocin should only be considered if the contraction frequency is low in the presence of epidural analgesia.
ACOG Committee Opinion 745: Mode of Term Singleton Breech Delivery
Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group
SOGC Guideline 384: Management of Breech Presentation at Term
RCOG Green Top Guideline 20b: Management of Breech Presentation
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