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External Cephalic Version (ECV)
Your baby is the wrong way round in your uterus. The correct position for delivery is with your baby’s head down towards the neck of your uterus, called your cervix. About three in 100 (3%) babies are breech presentations, meaning their bottoms are closest to the cervix. Alternatively, your baby may be in a transverse position. In this position your baby lies from side to side across your abdomen. Both of these positions are abnormal presentations. There are many reasons why this happens but quite often the cause is not clear.
What is an external cephalic version (ECV)?
This is a procedure to turn your baby around so that it is in the correct position for delivery. It is usually done around week 37 of pregnancy. During an ECV an obstetrician will gently move your baby by pressing their hands on your abdomen.
What has gone wrong?
Reasons for an abnormal presentation include:
~ Abnormal shape of your uterus - A normal uterus is shaped like an upside down pear. Occasionally, the uterus is heart shaped or partially divided into two, called a bicornuate uterus. If your uterus has an abnormal shape this may stop your baby from lying in the correct position.
~ Too much fluid around your baby - Your baby is surrounded by a liquid, called the amniotic fluid. If there is too much fluid, especially near the end of pregnancy, your baby may keep turning. Your baby is then more likely to end up in an abnormal position.
~ Low-lying placenta - The afterbirth is also called the placenta. Placenta previa is a condition where your placenta lies low in your uterus. This may be in the way, stopping your baby from lying in the correct position.
~ Fibroids - These are non-cancerous lumps, sometimes found in the muscle wall of the uterus. They may be in the way of your baby.
~ The stage of the pregnancy - In early pregnancy many babies are in the breech position. They usually turn around near the end of the pregnancy but some do not.
Several causes for abnormal presentation also prevent a successful ECV. For instance, if you have a bicornuate uterus we will not offer you an ECV, as it may not be possible to turn your baby.
Commonly there is no clear reason for your baby to be lying in an abnormal position. It is for these cases that we usually offer an ECV. Discuss the reason for your baby’s abnormal presentation and the possibility of having an ECV with your obstetrician.
The safest way to deliver a breech baby is through a cut in your abdomen, called a Caesarean section. A successful ECV can allow you to avoid this and have a normal vaginal delivery.
Are there any alternatives?
If your baby stays in a breech position we usually advise delivery by Caesarean section. Some obstetricians may be willing to deliver a breech presentation vaginally.
Who should not have the procedure?
We will not consider you for an ECV if:
~ you have a multiple pregnancy, such as twins or triplets
~ you have bleeding before the delivery, called an antepartum haemorrhage
~ your placenta is low-lying, called placenta previa
~ you need a Caesarean section for another reason regardless of presentation
~ your membranes have already ruptured
~ there is a severe fetal abnormality
~ there is no amniotic fluid surrounding your baby.
We may consider you for an ECV if:
~ you have had a previous Caesarean section
~ you have high blood pressure, called hypertension
~ your baby has restricted growth (IUGR)
~ you are obese.
What if you do nothing?
Without an ECV your baby may still turn by itself. If it does not turn you will usually have a more difficult labour with more risks and complications. You may need a Caesarean section to deliver your baby. Carefully discuss your options with your obstetrician.
Author: Dr Chineze Otigbah MRCOG. Consultant obstetrician and gynaecologist.
© Dumas Ltd 2006