McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
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What is external cephalic version?

External cephalic version is the changing of a baby's position in the uterus by manipulation of the mother's abdomen. Usually it is done to turn a breech baby to a vertex (headfirst) position. A breech baby's bottom or feet are in a position to come out before the head during delivery through the birth canal. Such a delivery may be hazardous. For example, the baby's head may become trapped in the mother's cervix. If the baby is moved to a headfirst position, you may avoid having a vaginal breech delivery or cesarean section.

When is it used?

External cephalic version may be done when your baby is in the breech position near your due date. Your health care provider may diagnose a breech position by feeling your abdomen and locating the baby's head and bottom. You may also have an ultrasound to check the baby's position.

Women with the following conditions may be advised against having this procedure:

• pregnancy with more than one baby
• placenta previa (the placenta is near or covering the opening of the uterus)
• an anterior placenta (the placenta is attached to the front wall of the uterus)
• vaginal bleeding
• low level of fluid in the sac around the baby
• uterine malformation, such as a double or septate uterus
• heart disease
• high blood pressure
• previous cesarean section
• Rh-negative blood type.

External cephalic version may also not be advised if you are already in labor or if your baby has:

• an abnormal fetal heart rate pattern
• suspected intrauterine growth retardation (slowed growth)
• a major fetal anomaly, such as an abnormally large head (hydrocephaly).

What happens during the procedure?

This procedure is usually done in the hospital either in or near the labor and delivery unit.

Just before the procedure an ultrasound will be done to confirm the position of the baby and placenta. A nonstress test will be done to make sure the baby's heart rate is normal.

During the procedure, medication is given to relax your uterus. In rare cases epidural anesthesia may be given. The doctor then places his or her hands on your abdomen, locates the baby's parts, and gently pushes the baby's bottom out of your pelvis. The doctor then tries to maneuver the baby so that the head will enter the pelvis.

The baby's heart rate is monitored during the procedure.

What happens after the procedure?

After the procedure a nonstress test is done again to check the baby's well-being.

If the procedure is unsuccessful, your doctor will discuss the risks and merits of vaginal delivery compared with cesarean section in your particular case. Even if the procedure is successful, the baby could return to the breech position before you begin labor.

What are the risks associated with this procedure?

Some of the potential complications of this procedure include:

• premature labor in about 1% of mothers
• premature rupture of the membranes in about 1% of mothers
• a small amount of blood loss from you and the baby
• the need for an emergency cesarean section because the baby is not getting enough oxygen, usually because of a pinched umbilical cord
• damage to the placenta, possibly causing separation of part or all or it.

The likelihood of these complications is small. However, any of these problems can be very serious. For this reason, many doctors prefer not to do external cephalic versions.

When should I call the doctor?

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.