External Cephalic Version

INTRODUCTION Breech delivery carries a higher mortality than vertex delivery, Some of this mortality is due to factors which will be reduced or eliminated by external cephalic version (ECV) before labour. These include: (1) Cord prolapse, (2) Uncontrolled delivery of the head, causing rapid compression and decompression without moulding, and cerebral haemorrhage. (3) Asphyxia due to delayed delivery of the head because of cephalopelvic disproportion or an incompletely dilated cervix. (4) Meconium aspiration when strong inspiratory attempts occur with the head in the pelvis. The increased risk of these complications has led obstetricians to practice ECV at various times in the antenatal period. Although there has been some controversy regarding its effectiveness, numerous trials have now confirmed that ECV will reduce the incidence of breech presentation at term. At first sight, therefore, ECV is a worthwhile procedure and for many years has been standard obstetric practice all over the world. However, in developed countries these risks of breech delivery have fallen dramatically. The reasons are as follows: (1) Delivery is more often conducted in hospital by senior personnel. (2) There is greater emphasis on controlled delivery of the head. This is aided by the routine use of forceps and epidural anaesthesia in many centres. (3) Improved facilities have resulted in quicker emergency Caesarean sections if cord prolapse or unexpected delay in the second stage does occur. (4) Improved maternal nutrition in childhood has reduced the incidence of pelvic contraction and therefore of arrest of the aftercoming head. (5) There is greater recourse to Caesarean section for certain groups of breeches, notably low fetal weight, footlings, babies with hyperextended heads, and mothers with borderline pelvises. In some centres Caesarean section rates for breeches are now over 50%.