An observational study of the success and complications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwives

BJOG. 2016 Feb;123(3):415-23. doi: 10.1111/1471-0528.13234. Epub 2015 Feb 2.


Objective: To evaluate the success of an external cephalic version (ECV) training programme, and to determine the rates of successful ECV, complications, and caesarean birth in a low-risk population.

Design: Prospective observational study.

Setting: Primary health care and hospital settings throughout the Netherlands (January 2008-September 2011).

Population: Low-risk women with a singleton fetus in breech presentation, without contraindications to ECV, were offered ECV at approximately 36 weeks of gestation.

Methods: Data were collected for all ECVs performed by midwives, and were entered into a national online database.

Main measures: Successful ECV was defined as the fetus having a cephalic presentation immediately following the procedure and at birth. Complications were observed at ≤ 30 minutes and between 30 minutes and 48 hours after the ECV procedure. All serious pregnancy outcomes that occurred after the ECV procedure until birth were reported.

Results: A total of 47% had a successful ECv and a cephalic at the time of birth: 34% of nulliparous and 66% of multiparous women. After ECV, 57% of women gave birth vaginally: 45% of nulliparous women and 76% of multiparous women. Within 30 minutes after ECV, and between 30 minutes and 48 hours after ECV, the proportion of women experiencing a complication or serious pregnancy outcome was 0.9% and 1.8%, respectively. Serious pregnancy outcome at any time following ECV until birth was experienced by 58 (2.5%) of the women.

Conclusions: The success rate of ECVs performed by trained midwives in primary health care or hospital settings is comparable with that of other providers, and the procedure is safe for low-risk women.

Keywords: Breech presentation; caesarean section; external cephalic version.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breech Presentation / therapy*
  • Cesarean Section / statistics & numerical data
  • Female
  • Humans
  • Midwifery / education*
  • Pregnancy
  • Prospective Studies
  • Risk Factors
  • Treatment Outcome
  • Version, Fetal / adverse effects
  • Version, Fetal / methods*