External Cephalic Version and Reducing the Incidence of Term Breech Presentation (Green-top Guideline No. 20a)

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Post category

Corresponding Author

the Royal College of Obstetricians, Gynaecologists

Publish date

03/16/2017
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Comment count

Executive summary of recommendations

External cephalic version (ECV)

How effective is ECV in preventing noncephalic birth?

Women should be informed that the success rate of ECV is approximately 50%.

Grade of recommendation: A

Women should be informed that after an unsuccessful ECV attempt at 36 +0 weeks of gestation or later, only a few babies presenting by the breech will spontaneously turn to cephalic presentation. [New 2017]

Grade of recommendation: B

Women should be informed that few babies revert to breech after successful ECV. [New 2017]

Grade of recommendation: B

Women should be informed that a successful ECV reduces the chance of caesarean section.

Grade of recommendation: A

Does ECV affect the outcome of labour?

Women should be informed that labour after ECV is associated with a slightly increased rate of caesarean section and instrumental delivery when compared with spontaneous cephalic presentation.

Grade of recommendation: B

Can the success of an ECV attempt be predicted?

ECV success can be predicted to some extent, but the use of models to predict success should not be used routinely to determine whether ECV can be attempted. [New 2017]

Grade of recommendation: B

What methods can be used to improve the success rate of ECV?

Use of tocolysis with betamimetics improves the success rates of ECV.

Grade of recommendation: A

Routine use of regional analgesia or neuraxial blockade is not recommended, but may be considered for a repeat attempt or for women unable to tolerate ECV without analgesia. [New 2017]

Grade of recommendation: B

When should ECV be offered?

ECV should be offered at term from 37+0 weeks of gestation.

Grade of recommendation: B

In nulliparous women, ECV may be offered from 36+0 weeks of gestation.

Grade of recommendation: ✓

What are the contraindications to ECV?

There is no general consensus on the eligibility for, or contraindications to, ECV.

Grade of recommendation: C

Women should be informed that ECV after one caesarean delivery appears to have no greater risk than with an unscarred uterus. [New 2017]

Grade of recommendation: C

What are the risks of ECV?

Women should be counselled that with appropriate precautions, ECV has a very low complication rate.

Grade of recommendation: B

What measures are appropriate to ensure fetal safety?

ECV should be performed where facilities for monitoring and surgical delivery are available.

Grade of recommendation: ✓

The standard preoperative preparations for caesarean section are not recommended for women undergoing ECV.

Grade of recommendation: ✓

Following ECV, EFM is recommended.

Grade of recommendation: ✓

Women undergoing ECV who are D negative should undergo testing for fetomaternal haemorrhage and be offered anti-D. [New 2017]

Grade of recommendation: D

Who should perform ECV?

ECV should only be performed by a trained practitioner or by a trainee working under direct supervision. [New 2017]

Grade of recommendation: ✓

How acceptable is ECV to women?

Although most women tolerate ECV, they should be informed that ECV can be a painful procedure.

Grade of recommendation: C

How could the uptake of ECV be increased?

The uptake of ECV is best increased by timely identification of the baby presenting by the breech and provision of evidence-based information.

Grade of recommendation: C

How can an ECV service be developed and audited?

There is no evidence to support any particular service model although larger institutions may consider a dedicated ECV clinic. [New 2017]

Grade of recommendation: ✓

What is the role of non-ECV methods?

Women may wish to consider the use of moxibustion for breech presentation at 33–35 weeks of gestation, under the guidance of a trained practitioner. [New 2017]

Grade of recommendation: C

Women should be advised that there is no evidence that postural management alone promotes spontaneous version to cephalic presentation.

Grade of recommendation: B

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