Anesthesia and External Cephalic Version

Breech presentation complicates 3–4 % of all term pregnancies. Among singleton births, a number of maternal and neonatal characteristics are associated with breech presentation including nulliparity, multiple fetus pregnancy, uterine abnormality, and older maternal age. External cephalic version (ECV) is a manual procedure that is advocated by national guidelines for breech presentation singleton pregnancy, in order to enable vaginal cephalic delivery. The alternative, in order to avoid vaginal breech delivery associated with reported neonatal complications, is cesarean delivery. ECV success rates are variable and influenced by maternal, obstetric, and fetal factors as well as practitioner experience. Success rates are increased when ECV is performed under neuraxial anesthesia. ECV is cost effective and relatively safe; however, women may elect to avoid ECV—opting for planned cesarean delivery instead.