Title : External cephalic version for term breech and non cephalic presentations: Experience at a secondary level hospital
Abstract:
Background: Rising cesarean delivery rates are a major obstetric concern worldwide. Fetal malpresentation at term is the third most common indication for cesarean birth and accounts for nearly one?sixth of all cesarean procedures. External Cephalic Version (ECV) is a non-invasive maneuver performed through the maternal abdominal wall to convert a breech, oblique, or transverse fetus to cephalic presentation and reduce the need for cesarean delivery.
Objective: To review current evidence on ECV, including success rate, safety, success predictors and to highlight its potential to lower cesarean section rates.
Methods: This article synthesizes data from recent reviews, clinical guidelines, and primary studies, including StatPearls (Shanahan et al., 2023) and a systematic review by Devold Pay et al. (2020), as well as key RCTs and cohort studies on ECV success, safety, and adjuncts such as tocolysis and neuraxial analgesia.
Results: Approximately 3–4% of fetuses remain in breech presentation at term. ECV performed from 36–37 weeks onward has a mean success rate of about 58–60%. Success is higher in multiparous women, those with a complete breech or transverse/oblique lie, unengaged presenting part, adequate amniotic fluid, and posterior placenta. Use of beta?2 agonist tocolysis (e.g., terbutaline) improves success rates. Serious complications occur in <1% of procedures; transient fetal heart rate abnormalities are the most common event. Successful ECV reduces the risk of cesarean delivery by roughly two?thirds and is cost?effective when the probability of success exceeds ~32%. ECV can be safely offered to women with a prior low?transverse cesarean and to selected women in early labor when facilities for immediate cesarean are available.
Conclusion: ECV is a safe, effective, and underutilized intervention that can significantly reduce term breech cesarean rates, particularly when supported by structured protocols, appropriate selection, and coordinated interprofessional care. Wider implementation, especially in settings with limited surgical capacity, has the potential to improve maternal and perinatal outcomes and decrease healthcare costs.
