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What are the potential complications of ECV?
External cephalic version is generally a very safe procedure. Potential complications include induction of labour as a result of the manipulation, placental abruption (partial detachment of the afterbirth) and cord entanglement.
If there is placental abruption or cord entanglement, the fetal monitoring performed immediately after will give clear evidence of fetal distress and, in such a case, an immediate delivery by caesarean section is carried out.
The fact that this manipulation can provoke labour or trigger delivery is one reason why earlier manipulation (before thirty-six completed weeks) is not usually advocated. This is to prevent the possibility of premature labour or delivery.
Can ECV be performed when labour has already started?
When external cephalic version is carried out after 36 weeks of gestation, does the presentation stay cephalic (head) thereafter?
In the majority, yes. The rate of spontaneous reversion back to breech is estimated to be less than 3 per cent.
If this happens, repeat ECV is not advocated. If ECV is performed earlier than thirty-six weeks, the possibility of reversion to breech is believed to be higher.
If a breech-presenting baby is left alone after 36 weeks, what are the chances that it will spontaneously convert to cephalic (head) presentation?
About 2 to 4%. That is, over 96 per cent of babies that are found to be breech at thirty-seven weeks will persist as breech thereafter. Some studies have claimed that up to 15 per cent of breech presentations will convert to cephalic after 37 weeks. Evidence of this is lacking in most centres.
Is the timing of delivery of any importance in a breech presentation?
It depends on the method of delivery.
If it is to be an elective caesarean section, in the absence of any compelling factors to do it earlier, delivery will be at 39 weeks (give or take a few days). This is ideal because the baby is then certainly mature. There is no point in going beyond the calculated expected date of delivery as nothing can be gained.
If the planned method of delivery is vaginal, one cannot influence the timing of delivery. Spontaneous labour is awaited and if this does not happen by 42 weeks of gestation, a review of plan is called for. This will mean reverting to caesarean section. Induction of labour is not normally an option when the baby is in a breech position.
If a woman goes into labour prematurely with a breech presentation, what will be the method of delivery?
Again there is no straightforward answer to this question.
For one, it depends on whether there are factors that rule out vaginal delivery from the outset. In the apparent absence of any such factors, the extent of prematurity will influence the method of delivery.
It is generally accepted that in mild to moderate prematurity (thirty-two to thirty-six weeks of gestation), caesarean section confers no advantage over vaginal delivery. Of primary importance will be the availability of the appropriate skills for whichever method of delivery is opted for.
In severe prematurity (below 30 weeks), a debate still rages on the best and least traumatic way of delivering these tiny babies. Most obstetricians still opt for caesarean section, but evidence to its superiority over vaginal delivery is weak. Regardless of the method of delivery, these babies tend not to fare very well.
Is vaginal breech delivery more difficult?
Not for the mother. However, for the person assisting in the delivery, it requires special skills and experience. It will always be conducted by a senior midwife or doctor. Many mothers find breech delivery easier than delivery of a head presenting fetus.