The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies

Abstract

ObjectiveTo investigate whether initiating external cephalic version (ECV) earlier in pregnancy might increase the rate of successful ECV procedures, and be more effective in decreasing the rate of non-cephalic presentation at birth and of caesarean section.DesignAn unblinded multicentred randomised controlled trial.SettingA total of 1543 women were randomised from 68 centres in 21 countries.PopulationWomen with a singleton breech fetus at a gestational age of 330/7 weeks (231 days) to 356/7 weeks (251 days) of gestation were included.MethodsParticipants were randomly assigned to having a first ECV procedure between the gestational ages of 340/7 (238 days) and 356/7 weeks of gestation (early ECV group) or at or after 370/7 (259 days) weeks of gestation (delayed ECV group).Main outcome measuresThe primary outcome was the rate of caesarean section; the secondary outcome was the rate of preterm birth.ResultsFewer fetuses were in a non-cephalic presentation at birth in the early ECV group (314/765 [41.1%] versus 377/768 [49.1%] in the delayed ECV group; relative risk [RR] 0.84, 95% CI 0.75, 0.94, P = 0.002). There were no differences in rates of caesarean section (398/765 [52.0%] versus 430/768 [56.0%]; RR 0.93, 95% CI 0.85, 1.02, P = 0.12) or in risk of preterm birth (50/765 [6.5%] versus 34/768 [4.4%]; RR 1.48, 95% CI 0.97, 2.26, P = 0.07) between groups.ConclusionExternal cephalic version at 34–35 weeks versus 37 or more weeks of gestation increases the likelihood of cephalic presentation at birth but does not reduce the rate of caesarean section and may increase the rate of preterm birth.

GNK-PIMS Score: A Predictive Model for Success of External Cephalic Version

“…[11][12][13] In our study, 82 women (49.9%) were successfully converted from breech to cephalic presentation. This was similar to that reported by Hutton et al (49.1%) 9 and Kuppens et al (55%). 10 The success rate in local studies varies from 47 to 67.5% while that in international studies is quoted from 48 to 77%.…”

Single-institute experience, management, success rate, and outcome after external cephalic version at term

“…ECV commenced at term can have the benefit of decreasing the rate of non-cephalic presentation and cesarean delivery [9]. ECV before 37 weeks increases the likelihood of cephalic presentation at birth, but also increases in the likelihood of preterm birth [12]. Multiparity, an amniotic fluid index of more than 7, pelvic presentation, an absent placenta previa, and a body mass index of less than 25 have been established as positive prognostic factors for ECV [13][14][15].…”

Using Moxibustion in Primary Healthcare to Correct Non-Vertex Presentation: A Multicentre Randomised Controlled Trial

“…Of these, the method most commonly adopted is external cephalic version which reduces the likelihood of non-vertex presentation births 6 without reducing caesarean sections. 7 Methods based on maternal posture or hypnosis and relaxation techniques to promote fetal version have also been recommended; they are widely used but their effectiveness remains unproven. 8 The application of heat from the combustion of Artemisia vulgaris (moxibustion) for therapeutic purposes has long been used in China.…”