Clinical Health Updates

External cephalic version safe

Clinical Question:
Is external cephalic version for breech presentation at term pregnancy safe?

Bottom Line:
In this series of 805 consecutive version attempts, they reported an extremely low complication rate and 0.5% risk of emergency caesarean section after the procedure.

Collins S, Ellaway P, Harrington D, Pandit M, Impey LW. The complications of external cephalic version: results from 805 consecutive attempts. BJOG 2007;114;636-638.

Study Design:
Case series

Currently most women with fetus in breech presentation at term pregnancy undergo elective cesarean delivery. These UK authors present the results of all external cephalic versions (n=805) performed at their institution between June 2000 and March 2006 to demonstrate complication rates. Included were singleton pregnancies at or beyond 36 weeks’ for nulliparous women and 37 weeks’ in multiparous women. Women were not eligible if they had an absolute indication for cesarean delivery, growth restricted fetus with abnormal umbilical artery Doppler index, ruptured membranes, Rh isoimmunization, severe preeclampsia, or recent vaginal bleeding. A detailed ultrasound was performed before version attempt and to aid during the procedure. Up to 2 version attempts were made using a forward roll technique. Fetal heart rate was monitored after the version attempt until a normal reactive tracing was obtained. There was one unexplained stillbirth at 40 weeks and 5 days of gestation, after an uncomplicated successful version at 37 weeks. There were no cases with evidence of fetal trauma. There were 4 emergency cesarean deliveries (0.5%) at the time of attempted version, one neonate with trisomy 21 and the other 3 with normal Apgar scores and cord pH levels. Version was successful in 357 of 805 cases (44%). Of women with successful versions 90% delivered vaginally.