What are the current guidelines for external cephalic version (ECV) in term breech presentations?

For women with an uncomplicated singleton pregnancy and a confirmed breech presentation after 36+0 weeks, current UK clinical guidelines recommend offering external cephalic version (ECV) as an option to turn the baby to a cephalic (head-down) position if the woman prefers a vaginal cephalic birth. This discussion should include the benefits, risks, and implications of ECV alongside other options such as breech vaginal birth and elective caesarean section ¹.

ECV should be performed in a setting where appropriate monitoring and emergency care are available, typically from 36 weeks gestation onwards, as this timing balances the likelihood of successful version with minimising the risk of preterm birth ¹. The procedure involves applying manual pressure to the maternal abdomen to turn the fetus externally and is generally considered safe when performed by experienced practitioners ¹.

Women should be fully informed about the procedure, including the possibility of discomfort, the chance of success (which varies but is generally around 50-60%), and the rare risks such as fetal distress or emergency caesarean section ¹. Shared decision-making is emphasised, ensuring that the woman’s preferences and understanding guide the management plan ¹.

Recent clinical practice guidelines from the French College of Gynaecologists and Obstetricians (CNGOF) align with the UK recommendations, endorsing ECV at term for breech presentations to reduce the rate of breech births and caesarean sections. They also highlight the importance of careful patient selection, contraindications (such as placenta praevia, ruptured membranes, or fetal compromise), and the need for appropriate fetal monitoring during and after the procedure (Ducarme, 2020; Sentilhes et al., 2020).

In summary, the current clinical approach integrates thorough counselling about all birth options, offering ECV at term to suitable women with breech presentations, performed in a controlled environment with appropriate monitoring and respect for the woman’s informed choice ¹ (Ducarme, 2020; Sentilhes et al., 2020).