title: The Impact of an ECV Service is Limited by Antenatal Breech Detection: A Retrospective Cohort Study.
abstract: BACKGROUND
  External cephalic version (ECV) reduces the chance of breech presentation at term birth and lowers the chance of a cesarean delivery. ECV services are now in place in many units in the United Kingdom but their effectiveness is unknown. The aim of this study was to investigate the reasons for breech presentation at term birth.
  
  
  METHODS
  We performed a retrospective cohort study of 394 consecutive babies who were in breech presentation at term birth in a large United Kingdom maternity unit that offers ECV. The cohort was analyzed over two time periods 10 years apart: 1998-1999 and 2008-2009.
  
  
  RESULTS
  Only 33.8 percent of women had undergone a (failed) ECV attempt. This low proportion was mainly because breech presentation was not diagnosed antenatally (27.9%). Other contributing factors were: ECV not offered by clinicians (12.2%), ECV declined by women (14%), and contraindications to ECV (10.7%). Over the 10-year period, the proportion of breech presentations that were not diagnosed antenatally increased from 23.2 to 32.5 percent (p = 0.04), which constituted 52.8 percent of women who had not undergone an ECV attempt in 2008-2009. Failure of clinicians to offer ECV reduced from 21.6 to 3.0 percent (p = 0.0001) and the proportion of women declining ECV decreased from 19.1 to 9.0 percent (p = 0.005). Overall, ECV attempts increased from 28.9 to 38.5 percent (p = 0.05).
  
  
  CONCLUSIONS
  Although ECV counseling, referral, and attempt rates have increased, failure to detect breech presentation antenatally is the principal barrier to successful ECV. Improved breech detection would have a greater impact than methods to increase ECV success rates.
authors: Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK.|School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Joris
authors: J
authors: Hemelaar
authors: Department of Obstetrics & Gynaecology, The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
authors: Lee N
authors: LN
authors: Lim
authors: Fetal and Maternal Medicine, The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
authors: Lawrence W
authors: LW
authors: Impey
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000379:methods / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D047929:Term Birth; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014710:Version, Fetal / Q000379:methods / Q000706:statistics & numerical data
keywords: breech presentation; counseling; external cephalic version; vaginal breech birth