Experience with external cephalic version and selective vaginal breech delivery in private practice.

OBJECTIVE

The purpose of this study was to decrease the rate of cesarean delivery for breech presentation through use of a protocol that calls for external cephalic version and selected vaginal delivery of the infant in breech position.

STUDY DESIGN

I offered external cephalic version to patients whose fetuses were in the breech position beyond 36 weeks' gestation and who were not in active labor. Patients in active labor were included in the review if they agreed to a trial of labor.

RESULTS

Sixty-five deliveries were included in this review. The success rate of the version procedure was 53%. Among patients in whom version was successful 28% required cesarean delivery. Of those remaining breech fetuses believed to be candidates for vaginal delivery, 80% were successfully delivered vaginally. The overall vaginal delivery rate was 31 of 65 deliveries, or 48%.

CONCLUSION

Protocols that call for external cephalic version with vaginal delivery of selected fetuses in breech presentation that either do not respond to or are not candidates for version can be used in the private practice setting. Such protocols should result in a decreased number of cesarean sections.