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ECV Summary & References


  1. All women with a breech pregnancy at or near term should be offered an ECV if there are no contraindications.​
  2. Average success rate approximately 49-58% with lower rates in nulliparous women.​
  3. Early ECV increases the likelihood of cephalic presentation at birth with no decrease in c-section rate or increase in preterm birth risk.​
  4. Prior low transverse c-section is not a contraindication to ECV.​
  5. Limited evidence on contraindications but should not offer if suspicion of abruption, maternal preeclampsia/HELLP, or fetal distress.​
  6. ECV mostly likely to succeed if multiparous, normal BMI, fore-bag >1 cm, and performed by experienced providers.​
  7. No evidence for alternatives to ECV such as postural management and moxibustion.

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  • Cluver  C, Gyte  GML, Sinclair  M, Dowswell  T, Hofmeyr  GJ. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD000184. DOI: 10.1002/14651858.CD000184.pub4. Accessed 04 April 2021.​
  • Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev. 2012 May 16;(5):CD003928. doi: 10.1002/14651858.CD003928.pub3. Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation. Cochrane Database Syst Rev. 2000;(3):CD000051. doi: 10.1002/14651858.CD000051. Update in: Cochrane Database Syst Rev. 2012;10:CD000051. ​
  • Daniek Thissen, Pauline Swinkels, Remke C. Dullemond, Jan Willem van der Steeg, Introduction of a dedicated team increases the success rate of external cephalic version: A prospective cohort study, European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 236, 2019, Pages 193-197.​
  • Dochez, V,  Esbelin, J,  Misbert, E, et al.  Effectiveness of nitrous oxide in external cephalic version on success rate: A randomized controlled trial. Acta Obstet Gynecol Scand.  2020; 99: 391– 398. https://doi-org.ezproxy.library.ubc.ca/10.1111/aogs.13753
  • Dunn M, Turtle P, for the Early ECV2 Trial Collaborative Group. The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies. BJOG 2011;118:564–577.​
  • External cephalic version: ACOG practice bulletin, number 221. Obstetrics and gynecology (New York. 1953). 05/01/2020;135(5):e203-e212. Grootscholten, Kim MSc1; Kok, Marjolein MD1; Oei, S Guid MD, PhD2; Mol, Ben W. J. MD, PhD1; van der Post, Joris A. MD, PhD1 External Cephalic Version–Related Risks, Obstetrics & Gynecology: November 2008 – Volume 112 – Issue 5 – p 1143-1151 doi: 10.1097/AOG.0b013e31818b4ade​
  • Homafar, Mona MD; Gerard, Jessica MD; Turrentine, Mark MD Vaginal Delivery After External Cephalic Version in Patients With a Previous Cesarean Delivery, Obstetrics & Gynecology: November 2020 – Volume 136 – Issue 5 – p 965-971​
  • Hutton E, Hannah M, Ross S, Delisle M, Carson G, Windrim R, Ohlsson A, Willan A, Gafni A, Sylvestre G, Natale R, Barrett Y, Pollard J, Melo, P,  Georgiou, EX,

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Updated on February 16, 2022

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