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Pregnancy Bliss | Reproductive Health Hub

Are congenital abnormalities more common in breech-presenting babies?
Yes. In any cases where the fetus remains persistently breech without an obvious explanation, an ultrasound scan is performed, to search for possible congenital abnormalities as a potential explanation for the presentation, among other things.
The overall rate of major congenital abnormalities among newborns is around 3%. Among breech-presenting babies, the figure is 10 -12%. This is one of the main reasons why death and illness just before or after the birth (whatever the mode of delivery) is significantly higher among breech babies than in those presenting with head first.

Breech: Options available to the mother
Is there any alternative to breech vaginal delivery and caesarean section?
Yes, there is a third alternative and that is ‘external cephalic version’ (ECV).

What is external cephalic version?
External cephalic version (ECV) is where a manoeuvre is performed to turn the baby inside the womb from breech to cephalic presentation (head first). An experienced doctor in hospital performs this man­oeuvre usually after thirty-six weeks of gestation. It lasts about five to ten minutes and has a success rate of about 50 per cent.
The manipulation is performed only in the absence of contraindications such as:

Multiple pregnancy

Previous multiple caesarean sections

Vaginal bleeding

Low lying placenta (placenta praevia)

Pre-eclampsia or any hypertensive disease

Intrauterine growth restriction (IUGR).

The presence of any one of these precludes use of this manoeuvre.

Is ECV painful?
No, External Cephalic Version (ECV) should not be. Most practitioners use an injection of a drug to relax the womb to facilitate manipulation. The manipulation may cause discomfort but is not painful. Generally, if it is to succeed, it happens very quickly before you are aware of what is happening. Most experienced practitioners will tell you that, if it hasn't worked in the first three to four minutes, it is unlikely to do so, and hence most will give up at this stage.

Can't this manoeuvre be performed under a general anaesthetic?
The majority opinion is that this is unwise, because it allows for the risk of trying too hard. The amount of discomfort that the woman feels is considered a useful safety factor. With a general anaesthetic, this will be abolished, potentially putting the fetus in peril in the process.

Is the ECV manoeuvre safe?
Very safe. It is estimated that fetal death as a result of ECV is about two or three per 1000. Even this is probably a gross over-estimation. The safety checks are both simple and effective. After every manipulation, whether it succeeds or fails, the baby is monitored for at least thirty minutes. If the manoeuvre has caused anything which could lead to fetal distress, this will be immediately apparent and the necessary action will be taken promptly.

©2002 McKesson Health Solutions, LLC

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