External Cephalic Version

Definition - What does External Cephalic Version mean?

External cephalic version, or ECV, is turning the breech baby from buttocks or foot first to the normal head-first position by applying pressure on the mother’s uterus. (External means from outside the abdomen, cephalic means head-down presentation, and version means turning). ECV is a manual procedure carried out late in pregnancy, preferably at 37 weeks. It enables an easy vaginal birth by rotating a breech baby into a head-down position and avoids the risks that might occur with a vaginal breech or cesarean delivery.

FertilitySmarts explains External Cephalic Version

Throughout the pregnancy, the baby keeps moving around and changing positions. Most babies will flip to a head-down, or ‘cephalic,' position by 36 weeks of pregnancy. But about 3 in 100 babies will still be in a breech position at 36 weeks. After this period, spontaneous settling into a head-first position is not possible as the baby is big enough and has less room to move around. This makes the delivery challenging as opposed to the normal head-first or cephalic position. This is where the role of manually turning the baby into the desired position via ECV comes into play.

ECV is performed close to emergency facilities should a vaginal delivery or cesarean section becomes necessary. Prior to ECV, ultrasound helps confirm the position of the baby. During ECV, the baby's heart is monitored with the help of an electronic monitor called cardiotocograph. Ultrasound may also help guide the turning. To relax the uterus and ease the procedure, the doctor may also inject a medicine into the mother’s vein.

The doctor performs ECV by placing the hands on the mother’s tummy after applying an ultrasonic gel to facilitate the movements of the hands. Then, by applying firm pressure to roll the baby step by step from breech to a sideways position, the last maneuvering leads to a head-first presentation. If any problem occurs with the mother or the baby, the doctor will halt the ECV right away, and will carry out the necessary preparations for cesarean delivery.

As with any other procedure, complications may arise during ECV, such as:

  • Premature bursting of the amniotic sac
  • Premature labor
  • Changes in the baby’s heart rate
  • Severe discomfort to the mother
  • Premature separation of the placenta from the wall of the uterus (placental abruption)

According to the American College of Obstetricians and Gynecologists, ECV is successful in more than 50% of cases. Having said that, some babies may still flip back into a breech presentation after a successful attempt at ECV. If this happens, the doctor may attempt ECV again.

There are a few conditions where ECV cannot be carried out. The doctor will not try ECV if:

  • the mother is carrying more than one baby
  • the baby has an abnormal heartbeat or other health concerns
  • the woman’s uterus is heart-shaped (called a bicornuate uterus) instead of the normal pear shape
  • the placenta is in the wrong place such as low-lying placenta, or placenta previa
  • the placenta tears away from the uterus (placental abruption)
  • the water has broken before time

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