External cephalic version for the management of breech presentation
RHL practical aspects by Lede R
Breech presentation is now recognized as an abnormal presentation, irrespective of the fact that under ideal labour conditions actual fetal diameters are compatible with maternal pelvic dimensions. During delivery however, deflexion of the arms or the head can delay delivery, which can potentially harm the fetus. Currently, high quality evidence shows that caesarean section is the elective way to deliver a fetus in breech presentation. If no operative facilities are available, allowing vaginal breech delivery should be evaluated carefully by an experienced obstetrician.
FIRST CONTACT (PRIMARY CARE) LEVEL
In this setting, appropriate management of breech presentation requires timely antenatal diagnosis and avoiding breech presentation at delivery. When a persisting breech presentation is diagnosed or suspected, it is advisable to refer the patient to a hospital with operative facilities for ECV.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
The same recommendations for a primary care setting are applicable here as well. ECV should be attempted for women at term with no contraindications. If this procedure is not possible, an expert obstetrician should keep the patient under continuous observation, focusing on uterine activity, fetal descent and trying to keep membranes intact as long as possible. The person assisting the delivery should be skilled and experienced in the manoeuvres to assist breech deliveries.
This document should be cited as: Lede R. External cephalic version for the management of breech presentation: RHL practical aspects (last revised: 13 March 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.