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External cephalic version, or version, is a
procedure used to turn a fetus from a breech position or side-lying (transverse) position
into a head-down (vertex) position before labor begins. When successful,
version makes it possible for you to try a vaginal birth.
is done most often before labor begins, typically around 37 weeks.
Version is sometimes used during labor before the
amniotic sac has ruptured.
A scheduled cesarean is used to
deliver most breech births if a version doesn't work.
To avoid harm to the fetus, a
version procedure is closely monitored.
Before the version attempt, you
may be given an injection of
tocolytic medicine to relax the uterus and prevent
uterine contractions. The most commonly used tocolytic medicine is
While the uterus is relaxed, your doctor will attempt
to turn the fetus. With both hands on the surface of your abdomen—one by the
fetus's head and the other by the buttocks—the doctor pushes and rolls the
fetus to a head-down position. You will feel discomfort during a version
procedure, especially if it causes the uterus to contract. The amount of
discomfort depends on how sensitive your abdomen is and how hard the doctor
presses on your abdomen during the version attempt. If your fetus appears to be
in distress, as shown by a sudden drop in heart rate, the procedure is stopped.
If a first attempt at version is not successful in turning the
fetus, your doctor may suggest another attempt, possibly with
epidural anesthesia to help you relax and to reduce
pain associated with the procedure. Epidural anesthesia
may increase the success of repeated version attempts.footnote 1
complications are rare during external cephalic version. But they do happen.
This is why a version is performed in a hospital where you can have an
emergency C-section delivery if needed.
You and your fetus may be monitored
for a short time after a version attempt. You can resume your normal activities
after the procedure is over.
Version may be attempted
Version is usually not done
Version may pose a slight risk of opening a previous
C-section scar. Limited research data have shown that women with a cesarean
scar have had no such problems. But larger studies are needed to fully
assess the risk.footnote 2
In some cases, a
doctor will choose not to try a version when there is less amniotic fluid than
normal (oligohydramnios) around the fetus.
External cephalic version has an
average success rate of 58%.footnote 2 Version is most likely
to succeed when:footnote 3
Version is least likely to succeed when:footnote 3
Compared to the
first attempt, repeat version attempts are less likely to be successful.
With frequent monitoring, the risks of external
cephalic version to the mother and fetus are low.
of version, for which the fetus and mother are closely monitored,
In the rare case that labor begins or the fetus or
mother develops a serious problem during version, an emergency cesarean section
(C-section) may be done to deliver the fetus.
Version has a very small risk for
causing bleeding that could lead to mixing of the blood of the mother and
fetus. So a pregnant woman with
Rh-negative blood is given an Rh
immunoglobulin injection (such as RhoGAM) to prevent
Rh sensitization, which can cause fetal complications
in future pregnancies.
In rare cases, internal version is used to
deliver a second twin or is used during labor when an emergency threatens the life of
the fetus. In such a case, a doctor tries to turn the fetus by reaching into
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Klatt TE, Cruikshank DP (2008). Breech, other malpresentations, and umbilical cord complications. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 400–416. Philadelphia: Lippincott Williams and Wilkins.
American College of Obstetricians and Gynecologists (2000, reaffirmed 2012). External cephalic version. ACOG Practice Bulletin No. 13. Obstetrics and Gynecology, 95(2): 1–7.
Cunningham FG, et al. (2010). Breech presentation and delivery. In Williams Obstetrics, 23rd ed., pp. 527–543. New York: McGraw-Hill.
ByHealthwise StaffPrimary Medical ReviewerSarah Marshall, MD - Family MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerWilliam Gilbert, MD - Maternal and Fetal Medicine
Current as ofFebruary 5, 2016
Current as of:
February 5, 2016
Sarah Marshall, MD - Family Medicine
& Kathleen Romito, MD - Family Medicine & William Gilbert, MD - Maternal and Fetal Medicine
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