Is the External Cephalic Version Safe?

The external cephalic version is usually safe with a few risks observed.
The external cephalic version is usually safe with a few risks observed.

The external cephalic version is usually safe with a few risks observed. The success rate of the external cephalic version (ECV) is from 50% to 74% leading to a reduced rate of 9% to 16% in breech babies. As breech babies require a cesarean delivery, ECV reduces the need for cesarean delivery and associated surgical risks, which in turn, also helps to reduce the cost of delivery. Frequent monitoring also helps to reduce the risk of ECV in the mother and the child. The possible risk with ECV for which frequent monitoring is necessary includes:

  • Twisting or squeezing of the umbilical cord, obstructing the blood flow and oxygen to the fetus
  • Premature rupture of the membranes or PROM (commencement of labor when the amniotic sac around the fetus ruptures), or preterm labor
  • Placenta abruption (placenta separated from the wall of the uterus)
  • Fetus or mother may develop serious complications
  • Small risk of bleeding that could lead to the mixing of the mother’s blood and the fetus
  • Temporary change in the fetus’ heart rate
  • Loss of amniotic fluid

What is the external cephalic version?

External cephalic version is a procedure where the physician turns the fetus from a buttock or feet-down position (breech presentation) or a side-lying position (transverse position) to a head-down position (cephalic presentation) before the commencement of labor. The physician applies pressure on the abdomen to turn the fetus head-down. Presentation other than cephalic may pose difficulty in vaginal birth. Thus, ECV makes it easier for the physician to deliver by the vagina. If performed accurately, ECV avoids the need for cesarean delivery, thus avoiding its risk.

ECV is performed typically around 37 weeks before the beginning of labor.

When is the external cephalic version recommended?

External cephalic is recommended in women who are around 36 weeks pregnant and have a breech presentation. ECV is recommended when

  • Mother has a single fetus.
  • The fetus has not dropped to the pelvis.
  • There is enough amniotic fluid surrounding the fetus for sufficient turning of the fetus.
  • The mother has been pregnant before.


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When is the external cephalic version recommended?

ECV is usually avoided when

  • The amniotic sac is ruptured.
  • The mother has heart problems that make it difficult for her to receive tocolytic medicines to prevent uterine contractions.
  • There is fetal distress (fetal experiences oxygen deprivation).
  • There is placenta previa (placenta partially or completely covers the cervix) or placenta abruption.
  • The fetus’s neck is straight rather than being bent.
  • The fetus has a congenital defect.
  • The mother is pregnant with multiple fetuses.
  • The fetus doesn’t have a normal shape.

How is the external cephalic version performed?

Before an ECV, the physician administers tocolytic medicine to relax the uterus and prevent its contraction. When the uterus is relaxed, the physician places both their hands on the surface of your abdomen. Next, the physician pushes in the required direction until the fetus flips to the cephalic position. The physician continuously monitors the fetal heart rate, and if there is a dip in the heart rate, they may stop the procedure and opt for cesarean delivery. If the first attempt was unsuccessful, the physician might repeat the maneuver by giving epidural anesthesia to reduce the pain.