What risks are involved in the "version" procedure that a pregnant woman might endure if her baby is breech?

John

External cephalic version (ECV) is a process whereby the obstetrician attempts, by manipulating the baby through mom's belly, to turn the baby to a head-down position in preparation for delivery. Delivering a baby who is not head-down is risky and may require a cesarean section. To avoid that, a woman whose baby is breech (head-up) or transverse (sideways) may undergo ECV in hopes of turning the baby to the right position before delivery.

ECV can be uncomfortable for mom, but we do not use pain medications because we do not want to exert too much force. ECV may precipitate fetal distress, separation of the placenta, or labor. Sometimes significant distress may lead to an immediate cesarean section. In general, it is best to attempt ECV in a fully equipped labor and delivery suite with an operating room available.

ECV is usually attempted between 37 and 39 weeks of pregnancy. First an ultrasound is done to confirm the position of the baby. The heartbeat is monitored to make sure the baby is doing well before starting. An injection of terbutaline is given to prevent contractions, and an intravenous line may be started. The doctor tries to grab the baby's buttocks and head and do a "forward roll" motion to turn the baby around; sometime a "back flip" is used. If ECV is too uncomfortable for mom, or if monitoring shows persistent drops in the baby's heart rate, the procedure is stopped.

ECV is successful about 65 percent of the time. The chance of success is greatest if this is not a first pregnancy and if the ECV is attempted closer to 37 weeks.