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External cephalic version for breech presentation at termHofmeyr GJ, Kulier R
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SummaryExternal cephalic version for breech presentation at termExternal 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. 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 22. 1996 AbstractBackgroundManagement 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. ObjectivesThe 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 strategyWe searched the Cochrane Pregnancy and Childbirth Trials Register (April 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005) and PubMed (1966 to December 2004). Selection criteriaRandomised 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 analysisBoth authors assessed eligibility and trial quality, and extracted the data. Main resultsFive studies were included. The pooled data from these studies show a statistically significant and clinically meaningful reduction in non-cephalic birth (five trials, 433 women; relative risk (RR) 0.38, 95% confidence interval (CI) 0.18 to 0.80) and caesarean section (five trials, 433 women; RR 0.55, 95% CI 0.33 to 0.91) 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% 0.47 to 1.89) or five minutes (four trials, 368 women; RR 0.76, 95% 0.32 to 1.77), low umbilical artery pH levels (one trial, 52 women; RR 0.65, 95% 0.17 to 2.44), neonatal admission (one trial, 52 women; RR 0.36, 95% 0.04 to 3.24), perinatal death (five trials, 433 women; RR 0.51, 95% 0.05 to 5.54), nor time from enrolment to delivery (2 trials, 256 women; weighted mead difference -0.25 days, 95% -2.81 to 2.31). Authors' conclusionsAttempting 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. |