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External Cephalic Version and Reducing the Incidence of Term Breech Presentation (Green-top Guideline No. 20a)

Published: 16/03/2017

You can also access this guideline in PDF.

New evidence and guidance in this field were reviewed at the February 2020 Guidelines Committee meeting and it was decided that revision of this guideline would be deferred for 3 years (May 2023). The version available on the website and app will remain valid until replaced.

This is the second edition of this guideline, first published in 2006 under the title External Cephalic Version (ECV) and Reducing the Incidence of Breech Presentation.

This guideline presents the best evidence concerning methods to prevent noncephalic presentation at delivery and therefore caesarean section and its sequalae. The mode and technique of delivering a breech presentation is summarised in the Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20b Management of Breech Presentation.

Breech presentation, which complicates 3–4% of term deliveries, occurs most frequently in nulliparous women. Breech presentation is also more common in preterm deliveries. The publication of the Term Breech Trial led to the significant decrease in the number of women undergoing vaginal breech birth. Planned vaginal breech birth remains rare in the UK as in many countries and thus attempts to prevent breech presentation are important.

Declaration of interests:

Mr M Griffiths FRCOG, Eaton Bray is a member of Doctors for a Woman's right to Choose on Abortion. He is an unpaid member of a Quality Standards Advisory Committee at NICE, for which he does receive expenses for related travel, accommodation and meals.

Mr LWM Impey FRCOG, Oxford is Director of Oxford Fetal Medicine Ltd. and a member of the International Society of Ultrasound in Obstetrics and Gynecology. He also holds patents related to ultrasound processing, which are of no relevance to the Breech guidelines.

Professor DJ Murphy FRCOG, Dublin provides medicolegal expert opinions in Scotland and Ireland for which she is remunerated.

Dr LK Penna FRCOG, London: None declared.

Patient information

Information for women about breech baby at the end of pregnancy