External cephalic version: a safe procedure? A systematic review of version-related risks.
BACKGROUND
The Term Breech Trial has considerably increased the number of cesareans. External cephalic version (ECV) might be an effective method of lowering the rate of cesareans; its efficacy has been well established. However, although in the absence of anesthesia the risks are thought to be low, most studies have used populations too small to allow definite conclusions on version-related risks.


METHODS
In an attempt to make an inventory of these risks, we have systematically analyzed 44 studies, covering a total of 7377 patients from 1990 to 2002. The studies used were derived from a Medline and Embase search.


RESULTS
The most frequently reported complications were transient abnormal cardiotocography (CTG) patterns (5.7%). Persisting pathological CTG readings (0.37%) and vaginal bleeding occur rarely (0.47%). The incidence of placental abruption was even lower, at 0.12%. Fetomaternal transfusion was absent in five out of seven studies, with a mean incidence of 3.7%. Emergency cesareans were performed in 0.43% of all versions. Perinatal mortality was 0.16%.


CONCLUSIONS
External cephalic version seems to be a safe procedure.
Collaris
Ronald J
RJ
Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands.
Oei
S Guid
SG
D001946:Breech Presentation; D005260:Female; D006801:Humans; D011247:Pregnancy; D014710:Version, Fetal / Q000009:adverse effects / Q000379:methods*