External cephalic version for breech presentation at term

  • Review
  • Intervention

Authors

  • G Justus Hofmeyr,

    Corresponding author
    1. University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa
    • G Justus Hofmeyr, Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, 5200, South Africa. justhof@gmail.com.

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  • Regina Kulier

    1. Geneva Foundation for Medical Education and Research, Geneva, Switzerland
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Abstract

Background

Management of breech presentation is controversial, particularly in regard to manipulation of the position of the fetus by external cephalic version (ECV). ECV may reduce the number of breech presentations and caesarean sections, but there also have been reports of complications with the procedure.

Objectives

The objective of this review was to assess the effects of ECV at or near term on measures of pregnancy outcome. Methods of facilitating ECV, and ECV before term are reviewed separately.

Search methods

We searched the Cochrane Pregnancy and Childbirth Trials Register (September 2010), the Cochrane Central Register of Controlled Trials (2010, Issue 3) and PubMed (1966 to September 2010).

Selection criteria

Randomised trials of ECV at or near term (with or without tocolysis) compared with no attempt at ECV in women with breech presentation.

Data collection and analysis

Two reviewers assessed eligibility and trial quality, and extracted the data.

Main results

We included seven studies. The pooled data from these studies show a statistically significant and clinically meaningful reduction in non-cephalic birth (seven trials, 1245 women; risk ratio (RR) 0.46, 95% confidence interval (CI) 0.31 to 0.66; and caesarean section (seven trials, 1245 women; RR 0.63, 95% CI 0.44 to 0.90) when ECV was attempted. There were no significant differences in the incidence of Apgar score ratings below seven at one minute (two trials, 108 women; RR 0.95, 95% CI 0.47 to 1.89) or five minutes (four trials, 368 women; RR 0.76, 95% CI 0.32 to 1.77), low umbilical artery pH levels (one trial, 52 women; RR 0.65, 95% CI 0.17 to 2.44), neonatal admission (one trial, 52 women; RR 0.36, 95% CI 0.04 to 3.24), perinatal death (six trials, 1053 women; RR 0.34, 95% CI 0.05 to 2.12), nor time from enrolment to delivery (2 trials, 256 women; weighted mean difference -0.25 days, 95% CI -2.81 to 2.31).

Authors' conclusions

Attempting cephalic version at term reduces the chance of non-cephalic births and caesarean section. There is not enough evidence from randomised trials to assess complications of external cephalic version at term. Large observational studies suggest that complications are rare.

Plain language summary

External cephalic version for breech presentation at term

External cephalic version from 36 weeks reduces the chance of breech presentation at birth and caesarean section.

There is less risk to the baby and mother when the baby is head-down at the time of birth. External cephalic version (ECV) is a procedure by which the baby, who is lying bottom first, is manipulated through the mother's abdominal wall to the head-down position. The review of seven studies, 1245 women, found that If the baby is not head down after about 36 weeks of pregnancy, ECV reduces the chance that the baby will present as breech at the time of birth, and reduces the chance of caesarean birth.

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