External Cephalic Version for Breech Presentation at and Near Term

Objectives: To determine the safety of procedure external cephalic version (ECV), the success of procedure at different gestational ages and to calculate the reduction in caesarean rate secondary to successful procedure. Study Design: Retrospective, descriptive study. Place and Duration of Study: from August, 2002 to July, 2003. Patients and Methods: This was a single centered retrospective descriptive study. It was carried out at the Department of Obstetrics and Gynecology at Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore from August 2002 to July 2003. Hundred cases were selected for study. Results: Most of the patients in this study were multiparous. Success rate of ECV in this study was 50%. Out of this successful group 88% persisted as cephalic and 12% experienced reversion of their fetuses to breech. Normal vaginal delivery rate was 80% in the successful ECV group. Remaining cases underwent emergency caesarean section either due to spontaneous reversion to breech or fetal distress of cephalic fetuses in labour. Unsuccessful ECV group constitute 50% of cases. Elective caesarean delivery rate was high i.e. 96% in this group. Only one had vaginal breech delivery. The remaining underwent emergency caesarean section for various indications including footling breech, delayed progress in first stage of labour or at patient's request. Multiparity was the factor associated with greater success. No relationship could be found of the birth weight of fetus with the success of procedure in this study. No complication was observed during and after ECV. Conclusion: All the pregnant women with uncomplicated breech presentation should be offered external cephalic version when they are approaching term. This will provide them an alternate management option without causing any harm to them and their fetuses. This will also help in reducing the number of caesarean sections for breech presentation.