Cephalic version by postural management for breech presentation

Cochrane Review by Hofmeyr GJ, Kulier R

This record should be cited as: Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000051. DOI: 10.1002/14651858.CD000051.

ABSTRACT

Title

Cephalic version by postural management for breech presentation

Background

Babies with breech presentation (bottom first) are at increased risk of complications during birth, and are often delivered by caesarean section. The chance of breech presentation persisting at the time of delivery, and the risk of caesarean section, can be reduced by external cephalic version (ECV - turning the baby by manual manipulation through the mother's abdomen). It is also possible that maternal posture may influence fetal position. Many postural techniques have been used to promote cephalic version.

Objectives

The objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. Procedures in which the mother rests with her pelvis elevated were evaluated. These include the knee-chest position, and a supine position with the pelvis elevated with a wedge-shaped cushion.

Search strategy

The Cochrane Pregnancy and Childbirth Group trials register (searched September 2001) and the Cochrane Controlled Trials Register (Cochrane Library, Issue 3, 2001) were searched.

Selection criteria

Randomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group.

Data collection and analysis

Eligibility and trial quality were assessed by one or both reviewers.

Main results

Five studies involving a total of 392 women were included. No effect of postural management on the rate non-cephalic births was detected, either for the subgroup in which no external cephalic version was attempted, or for the group overall (relative risk 0.95, 95% confidence interval 0.81 to 1.11). No differences were detected for caesarean sections or Apgar scores below seven at one minute.

Authors' conclusions

There is insufficient evidence from well-controlled trials to support the use of postural management for breech presentation. The numbers of women studied to date remain relatively small. Further research is needed.