External Cephalic Version and Reducing the Incidence of Term Breech Presentation

How can an ECV service be developed and audited?There is no evidence to support any particular service model although larger institutions may consider a dedicated ECV clinic.[New 2017] What is the role of non-ECV methods?Women may wish to consider the use of moxibustion for breech presentation at 33-35 weeks of gestation, under the guidance of a trained practitioner.[New 2017] CWomen should be advised that there is no evidence that postural management alone promotes spontaneous version to cephalic presentation. B1. Purpose and scopeExternal cephalic version (ECV) is the manipulation of the fetus, through the maternal abdomen, to a cephalic presentation.The purpose of this guideline is to describe and summarise the best evidence concerning methods to prevent noncephalic presentation at delivery and therefore, caesarean section and its sequelae.The evidence concerning mode and technique of the delivery of breech presentation is summarised in the Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 20b Management of Breech Presentation. 1 Introduction and background epidemiologyBreech presentation complicates 3-4% of term deliveries and is more common in nulliparous women and in preterm deliveries.Following the publication of the Term Breech Trial, 2 there was a significant decrease in the number of women undergoing vaginal breech birth.3 In many countries, including the UK, planned vaginal breech birth remains rare and attempts to prevent breech presentation at delivery remain important. Identification and assessment of evidenceThis guideline was developed using standard methodology for developing RCOG Green-top Guidelines.The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects [DARE] and the Cochrane Central Register of Controlled Trials [CENTRAL]), EMBASE, MEDLINE and Trip were searched for relevant papers.The search was inclusive of all relevant articles published between August 2005 and April 2016.The databases were searched using the relevant Medical Subject Headings (MeSH) terms, including all subheadings and synonyms, and this was combined with a keyword search.Search terms included 'breech', 'breech near presentation', 'breech presentation', 'breech near delivery', 'breech delivery', 'breech presentation and delivery', 'breech near extraction', 'breech extraction', 'Mauriceau-Smellie-Veit', 'Burns-Marshall', 'after-coming head' and 'external cephalic version'.The search was limited to studies on humans and papers in the English language.Relevant guidelines were also searched for using the same criteria in the National Guideline Clearinghouse and the National Institute for Health and Care Excellence (NICE) Evidence Search.Where possible, recommendations are based on available evidence.Areas lacking evidence are highlighted and annotated as 'good practice points'.Further information about the assessment of evidence and the grading of recommendations may be found in Appendix I. No. 20a e181 of e192 RCOG Guideline