External cephalic version ECV
External cephalic version ECV — part of pregnancy and antenatal care at Dr. Najeeb Layyous's clinic in Amman.
In short: External cephalic version is a manual procedure from outside the abdomen to turn a baby from the breech or transverse position to head-down, so that a caesarean may be avoided. It is done from week 36 in a first pregnancy and week 37 in later ones, and succeeds in about 50% (60% in women who have given birth before and 40% in a first pregnancy). It is not done with placenta praevia, bleeding, pre-eclampsia, twins or ruptured membranes.
Breech presentation occurs in 3-4 % of term deliveries, It is more common in preterm and nulliparous women. And It is associated with uterine and congenital abnormalities.
In many countries planned vaginal breech birth remains rare and attempts to prevent breech presentation remain important
External cephalic version is a manual procedure that is used to turn a baby from a breech or side-lying position to a head-down position in the womb in order to enable vaginal delivery .
During the procedure, the healthcare provider places their hands on the outside of the belly and attempts to rotate the baby. The baby’s heart rate is monitored to check for any problems.
A medicine to relax the uterus (such as terbutaline) is often given before the procedure because it increases the chance of success. If your blood group is Rh-negative, you will be given an anti-D injection afterwards.
-The success rate of ECV is 50 % ,Success levels are greater for multiparous women (60 %) than for nulliparous women (40%)
After successful ECV 3% of babies revert to breech
Labor after ECV is associated with a slightly increase risk of cesarean sections and instrumental delivery when compared with spontaneous cephalic presentation due to obstructed labor and fetal distress
ECV at term decreases non-cephalic presentation at delivery and decreases the rate of cesarean sections
The risk of cesarean section may be greater with a shorter ECV to labor interval
TIMING of ECV
In nulliparous women it is offered from 36 weeks
In multiparous women from 37 weeks
No upper gestational limit for when ECV can be offered
Contraindications to ECV:
- Where an absolute reason for CS already exists
- Placental abruption
- Placenta previa
- Recent vaginal bleeding ( less than 1 week )
- Severe PET
- Abnormal doppler or CTG
- Twins
- Rhesus isoimmunization
- Prelabor rupture of membranes
Complications of ECV
- Placental abruption
- Fetal bradycardia
- Fetomaternal hemorrhage
- Emergency CS due to abnormal CTG or vaginal bleeding or unexplained abdominal pain
Serious complications are uncommon: about 1 in 200 ECVs leads to an emergency cesarean, which is why ECV is performed where immediate delivery is available.
Who should perform ECV
It should only be performed by a trained practitioner
Predictors for successful ECV
- Multiparity
- Non engagement of the breech
- Palpable fetal head
- Maternal weight less than 65 kg
- Posterior placental location
- Complete breech presentation
- Amniotic fluid index more than 10
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
The finest doctor in Jordan — may God bless him and his whole medical team. A doctor in every sense of the word. I advise anyone planning a pregnancy to visit Dr. Najeeb Layyous. His manner is wonderful, always smiling, with the highest ethics; he gives every patient her due, and the patient’s comfort matters most to him. We had been to many doctors and none understood and treated my case except him. Special thanks to him and the whole team, and to Dina in particular — a lovely person. I recommend anyone considering IVF or pregnancy to visit his clinic.