PB 221: External Cephalic Version

Question 1

What is the percentage of breech presentation in term pregnancies?

Answer 1

3-4%

Question 2

What is the goal of External Cephalic Version (ECV)?

Answer 2

Decreases C/S rate and increases VD rate

Question 3

What are the benefits of ECV?

Answer 3

• Decreased chance of C/S
• Lower hospital charges
• Lower odds of developing endometritis, sepsis
• Shorter length of hospital stay

Question 4

What are the risks of ECV?

Answer 4

The following risks occur at a rate of < 1%:

• Placental abruption
• Umbilical cord prolapse
• Rupture of membranes
• Stillbirth
• Fetomaternal hemorrhage

Question 5

What are the success rates for ECV?

Answer 5

~50%

Question 6

What factors are predictive of ECV failure?

Answer 6

• Nulliparity
• Advanced dilatation
• EFW less than 2500 g
• Anterior placenta
• Low station

Question 7

How does the use of tocolysis affect the success rate of external cephalic version?

Answer 7

A randomized study of terbutaline found the success rate of ECV associate with its use to be almost double the success rate without its use

Question 8

How does the use of anesthesia affect the success rate of ECV?

Answer 8

Neuraxial analgesia can be considered a reasonable intervention to increase ECV success rate

Question 9

What is the algorithm for patient management for ECV?

Answer 9

Question 10

What is an example of a standard protocol for performing an ECV?

Answer 10

1. U/S to confirm malpresentation
2. Informed consent
3. Fetal well-being and contraction pattern before and after procedure
4. Use U/S to guide evaluation during procedure
5. Give Rhogam to Rh negative patients if delivery is not anticipated in the next 72 hours

Question 11

Summary of Recommendations: Level A and B

Answer 11