RHL Commentary by Roberto Lede
EVIDENCE SUMMARY
External cephalic version (ECV) is employed to avoid breech delivery in the management of breech presentation. Although ECV is apparently safe and highly successful when it is attempted before term, it is effective in reducing rates of vaginal breech delivery and caesarean section only when it is performed at term. None of the three studies included in the Cochrane Review, which analysed the use of ECV before term, detected a statistically significant reduction in breech delivery although, the results of repeated ECV were somewhat promising. Of the trials of ECV at term, all but one achieved a significant reduction in the rates of breech delivery.
Practitioners became enthusiastic with ECV before term in view of its high immediate success rate (about 70%), but this is followed by a high reversion rate. On the other hand, when ECV is practised at term non-cephalic presentation rate at delivery is lower than in the non-ECV group (32.6% vs. 78.3%). Caesarean section rate is not reduced if ECV is performed before term but it is almost halved when performed at term (15.8% vs. 30.1%). To this end, caesarean section rates in individual studies vary between 8% to 28% in the ECV groups and 11% to 74% in the control groups. Undoubtedly, these figures reflect the different management policies for breech presentation at delivery.
All identifiable clinical controlled trials met the predefined criteria for inclusion. All of them were included.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
References
This document should be cited as: Roberto Lede. External cephalic version: RHL commentary (last revised: 13 March 2006). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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