The implementation of external cephalic version at term for singleton breech presentation--how can we further increase its impact?

The overall incidence of breech presentation at delivery remained at 2 to 3% in a unit where external cephalic version (ECV) was the preferred treatment option for term singleton breech presentation. The objective of this study was to investigate which factors accounted for this high residual incidence, so that the impact of ECV could be further increased. All breech deliveries and ECVs over a 1-year period in a teaching hospital are reviewed. The incidence of term singleton breech delivery was 1.96% among 7,702 total deliveries. There were 115 patients counselled for ECV, of which 15.7% declined the offer and 4.1% went into labour before their scheduled ECV. Among the 93 ECVs performed, 74 were successful and 56 delivered vaginally in cephalic presentation. ECV was not performed in 131 cases. The major reasons were patients' refusal (13.7%), breech first diagnosed in labour or after rupture of membranes (44.3%), oligohydramnios or growth retardation (9.9%) and previous Caesarean section (8.4%). Only 5 patients were not counselled for ECV in the absence of contraindications. The practice of ECV reduced the overall Caesarean section rate by 0.65%, or 4.3% of the total number of Caesarean sections. In conclusion, ECV at term definitely reduces the Caesarean section rate. However, it is unlikely that the overall Caesarean section rate could be reduced by more than 1% even with 100% uptake of ECV unless the use of ECV is to be extended to those with prior Caesarean section, ruptured membranes, oligohydramnios, growth retardation or those who are in labour.