A busy labour ward, is this the right environment to have an ECV?

Dr Victoria Porter, Dr Sophia Andrews, Dr David Beaumont, Dr Katie Robinson. Lancashire Women and Newborn Centre, Burnley. 

 

 

 

Introduction

External Cephalic Version (ECV) is a procedure that aims to

reduce the incidence of term breech presentation.1 Vaginal

breech birth is associated with poorer neonatal outcomes2 and

women with breech presentation at term often choose caesarean

section, which places additional strain on obstetric services.3 ECV

involves turning the baby through the maternal abdomen to

achieve a cephalic presentation.4 At Lancashire Women and

Newborn Centre, ECV’s have historically been performed on the

labour ward by the on-call team. However, due to increased

labour ward activity, ECV’s were moved to a dedicated clinic on

the antenatal day unit (ADU). This study compared the outcomes

of ECV’s completed on labour ward with the dedicated clinic.

 

Methods

The data was collected

retrospectively, using electronic

records from 16th February 2024 to

16th October 2024. A total of 87

patients were reviewed and 60

patients fulfilled inclusion criteria

(figure 1). The Royal College of

Obstetrics and Gynaecology

guideline “External Cephalic Version

and Reducing the Incidence of Term

Breech Presentation, March 2017”

and local guidelines were used to

establish the audit standards.1

Results

From a recent study we conducted at our trust we demonstrated that a dedicated clinic has :

1. Increased success rates of ECV

2. Increased rates of vaginal delivery following successful ECV

3. Reduced waiting times for the procedure

98%

Felt they were

given sufficient

information

93%

Were happy with the

length of time spent

at the appointment

93%

Would

recommend this

clinic to others

 

Conclusion

The provision of a dedicated ECV clinic demonstrates increased success rates, higher

vaginal birth rates and an overall reduced appointment time. It could therefore be

derived that the overall patient experience is improved by having a dedicated clinic.

This research could be further enhanced by introducing patient feedback forms to

both units to be able to accurately compare direct patient experiences.

References

1.Impey LWM, Murphy DJ, Griffiths M, Penna LK on behalf of

the Royal College of Obstetricians and Gynaecologists.

External Cephalic Version and Reducing the Incidence of

Term Breech Presentation. BJOG2017; 124: e178–e192.

2.Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S,

Willan AR. Planned caesarean section versus planned

vaginal birth for breech presentation at term: a randomised

multicentre trial. Term Breech Trial Collaborative Group.

Lancet 2000;356:1375–83.

3. Rietberg CC, Elferink-Stinkens PM, Visser GH. The effect of

the Term Breech Trial on medical intervention behaviour and

neonatal outcome in The Netherlands: an analysis of 35,453

term breech infants. BJOG 2005;112:205–9.

4.Hofmeyr GJ, Kulier R, West HM. External cephalic version for

breech presentation at term. Cochrane Database Syst Rev

2015;(4): CD000083