The Implementation of External Cephalic Version at Term for Singleton Breech Presentation ‐ How Can We Further Increase Its Impact?
Authors: Lau Tze Kin , Lo Keith Wing Kit , Wan Din , Rogers Michael S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it gives a careful review of what may be achieved with a policy of external cephalic version in a large teaching hospital. One of the reviewers considered that although this was not a controlled trial that readers would like to be informed about any complications of the 93 external cephalic versions performed and given information about the perinatal outcomes for those who had attempted external cephalic version regardless of the mode of delivery and for those who had elective Caesarean section. The authors were asked to provide this additional information which follows. Author's response: (1) The complications of the 93 external cephalic versions were:

One case of fetal bradycardia which persisted for 4 minutes after the version. Emergency Caesarean section was performed and the baby was born in good condition
In 6 further cases there was transient fetal bradycardia which lasted for less than 1 minute in most cases.

Perinatal outcome for those who had attempted external cephalic version:

One case of mild asphyxia after normal spontaneous delivery
One case of cephalhaematoma after vacuum extraction
All 93 infants were livebirths and there were no neonatal deaths.

Perinatal outcome for those who had elective Caesarean section:

There were no cases of birth asphyxia or birth trauma
All infants were born alive and there were no neonatal deaths.

Summary: The overall incidence of breech presentation at delivery remained at 2 to 3% in a unit where external cephalic version (ECV) was the preferred treatment option for term singleton breech presentation. The objective of this study was to investigate which factors accounted for this high residual incidence, so that the impact of ECV could be further increased. All breech deliveries and ECVs over a 1‐year period in a teaching hospital are reviewed. The incidence of term singleton breech delivery was 1.96% among 7,702 total deliveries. There were 115 patients counselled for ECV, of which 15.7% declined the offer and 4.1% went into labour before their scheduled ECV. Among die 93 ECVs performed, 74 were successful and 56 delivered vaginally in cephalic presentation. ECV was not performed in 131 cases. The major reasons were patients' refusal (13.7%), breech first diagnosed in labour or after rupture of membranes (44.3%), oligohydramnios or growth retardation (9.9%) and previous Caesarean section (8.4%). Only 5 patients were not counselled for ECV in the absence of contraindications. The practice of ECV reduced the overall Caesarean section rate by 0.65%, or 43% of the total number of Caesarean sections. In conclusion, ECV at term definitely reduces the Caesarean section rate. However, it is unlikely that the overall Caesarean section rate could be reduced by more than 19b even with 100% uptake of ECV unless the use of ECV is to be extended to those with prior Caesarean section, ruptured membranes, oligohydramnios, growth retardation or those who are in labour.