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External cephalic version (ECV) Questions and Answers Grade A+
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External cephalic version (ECV) Questions and Answers Grade A+
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1|Page | © copyright 2024/2025 | Grade A+External cephalic version (ECV)
Questions and Answers Grade A+
Background
✓ Breech presentation complicates 3-4% of all term deliveries and a
higher proportion of preterm deliveries. It is more common where there
has been a previous breech presentation.
✓ -ECV at term reduces the incidence of noncephalic presentation at
delivery . Spontaneous version rates for nulliparous women are
approximately 8% after 36 weeks, but less than 5% after unsuccessful
ECV; success rates of ECV are 30-80%. Spontaneous reversion to
breech presentation after successful ECV occurs in less than 5%.
What is the success rate of ECV and what influences it?
Master01 | October, 2024/2025 | Latest update
, 1|Page | © copyright 2024/2025 | Grade A+
✓ An overal success rate of 40% for nulliparous, and 60% for multiparous
women can usually be achieved. The highest success rates are seen
with multiparous, non-white women with a relaxed uterus, where the
breech is not engaged and the head is easily palpable. Success rates
are also higher with increasing liquor volume, but, in practice, very high
liquor volume may be associated with spontaneous reversion. Maternal
weight, placental position, gestation, fetal size and position of the legs
make less difference and are probably not independent of other
factors.
✓ -The use of tocolysis with beta-sympathomimetics may be offered to
women undergoing ECV as it has been shown to increase the success
rate.The use of tocolysis should be considered where an initial attempt
at ECV without tocolysis has failed. A simple protocol is to offer a slow
intravenous or subcutaneous bolus of salbutamol or terbutaline either
routinely or if an initial ECV attempt has failed. Women should be
advised of the adverse effects of tocolysis with beta-2 agonists.
✓ -Where ECV fails the possibility of a further attempt should be discussed.
Master01 | October, 2024/2025 | Latest update
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