External cephalic version: a clinical experience

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Abstract
Eighty-five normal women underwent external cephalic version (ECV) for breech presentation in the late 3rd trimester. The protocol included real time ultrasonic scanning and pre- and post-procedure electronic fetal monitoring. Subcutaneous terbutaline sulfate (0.25 mg) was administered to (43/85 or 50.5%) of ECV candidates and rendered the procedure easier for patient and operator. A single operator, head-over-heels technique assisted by supine Trendelenberg''s position was used. Rh negative women were routinely administered 300 mcg of immune globulin. Successful ECG (53/85, 62.5%) was related to material parity, but not to gestational age nor eventual delivery weight. There were no acute material or fetal complications referable to ECV. One neonatal loss occurred due to a lethal congenital cardiac anomaly. In this series only engagement of the breech was reliable in predicting ECV failure. Fifty of 51 (98.1%) successfully verted women delivered a cephalic presentation infant at term. Cesarean section was performed in 5/51 of these patients (9.8%) for routine obstetrical indications. In one case, compound presentation at term resulting in dystocia and eventual cesarean section was believed related to prior successful version. In contrast, 15/30 (50%) of the ECV failure patients went on to operative delivery despite a liberal institutional policy toward term vaginal breech trials. In addition, the only serious fetal complication in this series, meconium aspiration, occurred in a vaginally delivered breech infant. It is unlikely that late 3rd trimester ECV will impact on our overall rate of cesarean delivery. In North America prematurity is the greatest risk factor in malpresentation and our policy increasingly is to permit attempts at term breech vaginal delivery. Nonetheless, ECV deserves serious consideration. When successful, ECV avoids the costs and/or risks of either cesarean section or vaginal trial of breech. As opposed to version practiced earlier in gestation, the merit of late 3rd trimester ECV is that more than 80% of spontaneous versions will have occurred by the time the procedure is attempted. Thus, most successful late version procedures occur in cases where spontaneous conversion is unlikely. In addition, babies successfully verted late in gestation are unlikely to spontaneously revert to breech (1/51 or 2% in our series). Under the protocol described herein, and in a limited series of patients, we found late 3rd trimester ECV 62.5% successful and clinically safe.

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