Successful but Limited Use of External Cephalic Version in Auckland

Abstract

The possibility of a noncephalic (breech) presentation at birth can be markedly reduced by the use of external cephalic version (ECV). Using ECV, practitioners place their hands on the woman's abdomen and gently turn the baby from the breech to cephalic position. A major review reported that ECV at or near term (≥36 weeks) reduced the occurrence of noncephalic births by 62% and the rate of cesarean section by 45%. In New Zealand and in many other countries, ECV is now recommended to all eligible women presenting with breech presentation at birth. This prospective study assessed: (1) the success rate for ECV at a tertiary teaching hospital in New Zealand, (2) the factors predicting success, (3) perinatal outcomes among women who underwent ECV, and (4) the percentage of women with term breech presentation who attempted the procedure. From 2002 to 2006, a prospective audit was conducted in all women with singleton breech presentation ≥36 weeks who attended the ECV clinic. Of the 255 women presenting for ECV, the procedure was successful in 150 (59%). Multivariate analysis showed that an unengaged presenting part was the strongest predictor of success; the adjusted relative risk (aRR) was 3.3, with a 95% confidence interval (CI) of 2.2 to 5.1. Other predictors of success were multiparity (aRR, 1.2; 95% CI, 1.0-1.4), and a lateral spine position (aRR, 1.5; 95% CI, 1.1-2.0). Among the 150 women with successful ECV, 100 (67%) had a vaginal birth; of the 105 women with unsuccessful ECV, only 1 had a virginal birth. To prevent 1 caesarean birth, 3 women had to attempt ECV. The rate of referral was low; only 26% of women with singleton term breech presentation attempted ECV. The success rate of ECV in reducing beech presentation at term in this study is consistent with that reported in previous studies. The procedure restored the rate of cesarean section to that of a cephalic singleton pregnancy at term. Further study is needed to address the low rate of referral and barriers to use of ECV in this population.