A century of changing views on ECV.

Abstract

Antenatal external version of babies presenting by the breech has been described for millennia but while extensively practised in continental Europe, was rarely practised in the United Kingdom, in part because abdominal palpation during pregnancy was considered unnecessary and therefore breech presentation was rarely diagnosed before labour (Spencer HR Br Med J 1901;1:1192–6). Even after routine antenatal assessments were introduced, there was a prejudice against the procedure. White, in 1956, counselled against routine version because (1) in 30% of nulliparous women and 70% of parous women spontaneous version occurred before the onset of labour, (2) fetal mortality from version ‘usually exceeded 1%’ and (3) breech delivery in hospital with appropriate medical staff present was ‘a safe procedure’ (White J Obstet Gynaecol Br Emp 1956;63:706–19). In 1959 Hay opined that ‘it is obviously safer nowadays, therefore, with a foetal loss of around 1% for breech delivery, for the baby to be delivered either vaginally as a breech or by caesarean section in selected cases than to have “external cephalic version” performed upon it’ (Hay J Obstet Gynaecol Br Emp 1959;66:529–47). During my training at King's College, St Mary's and Queen Charlotte's Hospitals in London, I never saw external cephalic version for breech presentation and so performing one never crossed my mind, until as a junior resident in 1978 I was teaching two medical students at Kingston Hospital. We came to a woman at 41 weeks of gestation with a baby presenting by the breech. One of the attending consultant obstetricians insisted on inducing labour in women with breech presentation at 39 weeks, which I and the senior resident thought was unnecessary and potentially dangerous, so we used to ‘hide’ such women on the antenatal ward and wait for the onset of spontaneous labour. I was explaining to the students the risks associated with breech presentation when the woman herself said ‘if my baby is the wrong way round, why don't you turn it the right way round?’. I smiled at her and explained to the students that at 41 weeks there was likely to be reduced amniotic fluid which would make it impossible to turn the baby even if I tried. So I demonstrated this and to my amazement the baby turned really easily. After that I used to do versions (at term) routinely in my clinic without any specific precautions and never saw any problems, except in one case where I turned the baby without specific consent and the mother was upset at being deprived of the elective caesarean section she had been promised—her mother and relatives were flying in from Denmark for the birth and had booked their flights appropriately. Luckily she did not make a formal complaint and I did not make that mistake again. External version is now regarded as a service which ‘should be available to all women at term’ with ‘few absolute contraindications’, although it should only be performed ‘where facilities for monitoring and immediate delivery are available’ (https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg20a/). None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.