External Cephalic Version
Turning Breech Babies for Safer Delivery
A comprehensive guide to External Cephalic Version procedures, success rates, and clinical considerations
Understanding Breech Presentation
When Baby's Bottom Comes First
Breech presentation occurs in approximately 3-4% of all pregnancies at term. The fetus presents with buttocks or feet first instead of the typical head-down position.
Variations of Breech Presentation
Complete Breech
OPTIMAL FOR VERSION
Both hips and knees flexed
Incomplete Breech
VERSION NOT ADVISABLE
One or both feet presenting
Frank Breech
POSSIBLE BUT DIFFICULT
Hips flexed, knees extended
External Cephalic Version Technique
🤲 Technique Points
- Gentle, continuous pressure
- One hand on fetal head
- Other hand on fetal breech
- Forward or backward somersault
⚠️ Safety Monitoring
- Continuous fetal heart monitoring
- Maternal comfort assessment
- Stop if excessive force needed
- Emergency cesarean readiness
Potential Complications
Failed Procedure
Most common outcome requiring cesarean delivery
Cord Entanglement
Umbilical cord complications requiring immediate delivery
Placental Abruption
Separation of placenta from uterine wall
Preterm Labor
Premature onset of contractions
Overall Complication Rate: 1-2% (Reference: J. Zhang & WA Bowes, Obstet Gynecol 1993)
Alternatives to External Cephalic Version
Postural Methods
Bridge position, knee-chest position
Acupuncture
Fifth toe and auricular point stimulation
Moxibustion
Traditional Chinese medicine using BL67 point
Chiropractic
Webster technique and other manipulations
Hypnosis
Relaxation techniques to encourage version
Optimal Timing and Key Takeaways
Best Timing for ECV
Early Term: 37+ weeks
Optimal balance of success and safety
Preterm ECV (34-35 weeks): Higher short-term success but increased reversion rates and cesarean risk
Delivery Options
- ✓ ECV followed by vertex delivery
- ⚠ Cesarean after failed version
- ◦ Primary cesarean delivery
- ◦ Vaginal breech delivery
