Pregnancy—external cephalic version
A breech presentation is when a baby is lying either bottom or feet first in the uterus and is common in early pregnancy. Most babies will turn by themselves into a head first position by 37 weeks of pregnancy. However, three to four per cent of babies will still be breech at 37 weeks.
External cephalic version offers an alternative to caesarean or vaginal breech births.
External cephalic version (ECV)
ECV is the procedure of turning a baby from a breech position to a head first position. A successful ECV means that the mother is able to plan for a vaginal birth.
Timing of the ECV
The best time to perform an ECV is after 36 weeks of pregnancy. Prior to 36 weeks the baby is still likely to turn on its own. ECV before 36 weeks may also increase the chance of preterm birth.
Suitability for ECV
Most women can have an ECV provided they have a healthy pregnancy with a normal amount of amniotic fluid. An ECV would not usually be performed with:
- third trimester bleeding
- an unusually shaped uterus (e.g. bicornuate uterus)
- a medical condition (e.g. high blood pressure or diabetes).
The success rate of ECV depends on a number of factors including the size of the baby, the amount of amniotic fluid and whether or not the woman has had a previous baby. The overall success rate for ECV is approximately 60 per cent.
The ECV procedure
Please plan to be at the hospital for up to three hours—this allows plenty of time for assessment before and after the ECV as well as the procedure itself. We recommend that you have someone to drive you home afterwards. If you are of Aboriginal and Torres Strait Islander descent, hearing impaired or need an interpreter please inform us prior to the procedure.
Before the ECV
An ultrasound scan will be performed to confirm that your baby is still breech, to check the size of your baby and the amount of amniotic fluid.
Once the ultrasound has been completed you will meet the midwife who will be caring for you. The midwife will monitor your baby using a cardiotocograph (CTG) which records your baby's heart rate pattern. This usually takes 20 to 40 minutes depending on whether your baby is awake or asleep at the time. The midwife will also check your pulse and blood pressure and answer any questions you may have.
During the ECV
The doctor will talk to you about the procedure, answer any more questions you may have and ask you to sign a consent form. A small needle will then be inserted into a vein in the back of your hand and a small amount of Ventolin injected into it. Ventolin will relax your uterus. It may also make your heart race—this is a normal reaction and will only last three to five minutes.
The doctor will cover your abdomen with ultrasound gel and use the ultrasound machine to confirm the position of your baby. While you are lying down the doctor will place their hands on your abdomen. Using firm pressure the doctor will rotate your baby in either a clockwise or anti-clockwise direction.
Normally, up to three attempts will be made to turn your baby. Each attempt lasts approximately three minutes.
After the ECV
The midwife will monitor your baby's heart rate again using the CTG machine. Women with a negative blood group require an injection of Anti-D following ECV.
You will need to make an appointment with a doctor at your antenatal clinic or your private obstetrician within the next week. If the ECV was successful they will confirm that your baby is still head down. If the ECV was unsuccessful they will discuss further management with you.
The risk of causing harm to the mother or the baby by ECV is low—less than one per cent. If any complications arise in association with ECV an emergency caesarean birth may be required.
A referral from a doctor is required to access services provided by the centre. Medicare requires a new referral for each ultrasound scan. Women should access their local obstetric service prior to being referred to the centre, so that ongoing care can be coordinated locally.
Not all services provided by the centre are covered by Medicare or your private health insurance. A gap payment will be incurred for most services. Bulk billing is available for women with pension or health care cards who present their cards on the day of their service. If you have any queries regarding fees, please discuss them with our staff prior to your visit by phoning 07 3163 1896.
Women travelling to the Mater Centre for Maternal Fetal Medicine for assessment, when their referring hospital is greater than 50 kilometres away from Mater, may be eligible to have some of their expenses reimbursed by their referring hospital under the Patient Travel Scheme (PTS). Further information is available via Queensland and New South Wales health department websites or by contacting your local hospital's travel coordinator.
Mater Hill Busway station is situated in the middle of Mater's South Brisbane campus. You can access bus timetables at http://translink.com.au/.
Parking is available on site at the Hancock Street Car Park and Mater Hill car parks.
Preparation for an ultrasound scan
Please eat and drink normally as a full bladder is not required for your ultrasound scan. However we request that you do not empty your bladder within 30 minutes of your appointment, unless you are uncomfortable, as some fluid in the bladder improves visualisation.
Please phone our reception on 07 3163 1896 if you are unable to attend your appointment. If you arrive late for your appointment it may need to be rescheduled.
Mater Centre for Maternal Fetal Medicine
Mater Mothers' Hospitals
South Brisbane Qld 4101
Phone: 07 3163 1896
Fax: 07 3163 1890
Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: HOSP-011-01853
Last modified 19/11/2015.