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2.1.3 Indications and Contraindications

Indications:

All women with a breech pregnancy at or near term should be offered an ECV if there are no contraindications.​ And if:

  1. Ultrasound confirmation of:
  • Non-vertex presentation
  • Normal amniotic fluid
  • Exclusion of fetal anomalies
  • Placental location

2. Reassuring NST or biophysical profile prior to the procedure.

3. Absence of contraindications.

Absolute Contraindications:

Vaginal delivery is contraindicated (Placenta previa, not a candidate for VBAC, etc.)

Relative Contraindications:

There are maternal, fetal and placental factors:

MaternalFetalOther
Uterine anomaly​*Preeclampsia/HTN
​Ruptured membranes​
APH​
*Abruption history​Active labour
​Cardiac disease
​Obesity​
ECG abnormalities
​Abnormal pelvis​
Age >45​
Allergies​
History of cesarean delivery​Diabetes
​Dilated cervix​
Grand multipara​Hyperthyroidism
​Irregular T4​
Growth restriction​*Abnormal cardiotocography​
Fetal anomaly
​Macrosomia​
Hyperextension of head
​Unstable lie​
*Doppler abnormalities
​Fetal distress​
Positive non-stress test​
Rhesus immunization​Uteroplacental transfusion​
Oligohydramnios​
Restrictive nuchal cord​Inexperienced obstetrician​Anterior placenta​
Polyhydramnios​
Single umbilical artery​
Source: ROSMAN et. al. (2013), Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstetricia et Gynecologica Scandinavica, 92: 137-142. https://doi.org/10.1111/aogs.12011

*Level III evidence for the following contraindications:

  1. Maternal history or sign of abruption​
  2. Maternal severe preeclampsia or HELLP​
  3. Fetal distress (abnormal cardiotocography or abnormal Doppler flow)

Is ECV safe in those with previous Cesarean Section?

Cesarean Section is not a contraindication for ECV.

Evidence

  • 6 cohort studies and 2 case-control studies with N = 14515​
  • Overall success found to be between 63-81%, similar to those without a previous c-section​
  • Vaginal delivery rate lower than those without a previous c-section (OR 0.26)​
  • No cases of uterine rupture during ECV were reported in women with a previous c-section ​

Conclusion:

Prior low transverse c-section is not a contraindication to ECV. ​

Updated on June 28, 2021

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