THE IMPACT OF EXTERNAL CEPHALIC VERSION ON THE RATE OF VAGINAL AND CESAREAN BREECH DELIVERIES - A 3-YEAR CUMULATIVE EXPERIENCE

The authors have reviewed the impact of their practice of external cep halic version (ECV) at term: with respect to success rate, factors ass ociated with successful version and the effect of this protocol on the overall breech and cesarean breech rate. Two hundred and forty-nine p arturients identified as having a breech presenting fetus after the 36 th gestational week over a 3-year period, after excluding contraindica ted cases, were offered a trial of ECV, with the use of ritodrine toco lysis. ECV was effected by one operator, using the minimally effective force necessary. Successful ECV was achieved in 196 attempts (78.7%). No deleterious effects in fetuses or mothers were noted. Of successfu lly turned fetuses, 78% eventually had a vaginal vertex delivery. Pari ty, birthweight and amount of amniotic fluid were found to have a sign ificant effect on the success rate of ECV, whereas gestational age at version or placental location were not found to have a significant eff ect on success rate. Introduction of the ECV protocol effected a signi ficant decrease in breech presentation at term, from 3.9 to 2.4% (P < 0.01), which can be translated into a decrease of 5.5% in the overall cesarean section rate. The authors conclude that ECV is a safe and eff ective procedure, in properly selected cases. Institution of a screeni ng protocol to identify breech presentation after 36 weeks, and utiliz ing ECV where possible, may lead to a significant reduction in the bre ech delivery rate, and may prevent serious infant morbidity.