Population: Pregnant women near term with breech presentation.
Organization
ACOG 2020
Recommendations
–Assess and document fetal presentation starting at 36 wk of gestation to allow for external cephalic version (ECV) when indicated and desired.
–Offer ECV to all women near term with breech presentations unless there are contraindications.
–Perform ECV after 37-0/7 wk, as spontaneous version is unlikely to occur after this gestational age, and the risk of spontaneous reversion is lower.
–For patients who are Rh-negative, give Rh-immune globulin unless known to have Rh-negative fetus, are already sensitized, or will be delivered in less than 72 h.
Practice Pearls
• Complications from ECV occur at rates less than 1% and include placental abruption, umbilical cord prolapse, ROM, stillbirth, and fetomaternal hemorrhage.
• Evidence supports the use of parenteral tocolysis to improve ECV success; adding neuraxial analgesia is reasonable.
• ECV is approximately 60% successful in achieving a cephalic vaginal birth.
Source
–Obstet Gynecol. 2020;135(5):e203-e212.