Is an External Cephalic Version (ECV) Worth the Risk?

If a fetus does not turn head-down at around the 37th week of gestation, a procedure known as an external cephalic version (ECV) may be recommended by an obstetrician.

The procedure attempts to externally rotate the position of the fetus to avoid the need for a cesarean section or breech vaginal delivery. Is an ECV worth the risks? This article explains what you need to know about the risks and benefits of an ECV.

When is an external cephalic version (ECV) recommended?

The majority of babies turn head-down by the 37th week of gestation. Head-down is the safest position for vaginal deliveries because as the baby’s head pushes through the cervix, it makes way for the shoulders and the rest of the body. If a baby comes out feet first or bottom first, there is a risk of the shoulders or head getting stuck, which is a medical emergency.

By the 37th week of gestation, if the baby has not turned naturally to a head-down position, an obstetrician may recommend an ECV procedure. If an ECV is not possible, it is likely that a cesarean section will be scheduled.

Breech vaginal deliveries may be a possibility depending on the maternal and fetal risk factors, potential complications, and the size of the baby.

How is an ECV performed?

To reposition the baby, the doctor will strategically externally push on the abdomen to attempt to get the baby to flip over. This abdominal pushing can cause discomfort, and pain-relieving medication may be offered.

Where is an ECV performed?

An ECV is usually performed in the hospital setting. In the event of complications and an emergency cesarean section is needed, the operating room should be nearby.

What are the risks?

ECVs are successful in turning the baby about 60% of the time. Although rare, there are risks associated with an ECV that may result in an emergency cesarean section or harm to the mother or baby. These risks may include the following:

• Placental abruption. Part of the placenta separates from the uterus, causing potential hemorrhaging and significant blood loss of the mother and baby.
• Premature rupture of membranes. The amniotic sac bursts or tears, breaking the water too soon.
• Premature labor. Contractions of the uterus begin, putting the mother in labor.
• Changes in the baby’s heart rate. Increase or decrease in fetal heart rate.

What happens if an ECV is not successful?

Studies have shown that over half of ECV procedures are successful in turning the fetus without complications. If the ECV fails, the obstetrician will discuss the next options available. Many breech babies end up being delivered by a scheduled cesarean section. Some may have the option to attempt a breech vaginal delivery.

Since ECVs are successful over half of the time, and serious risks are rare, attempting an ECV may prevent the need for a cesarean section and allow for a healthy vaginal delivery.