Medically Reviewed by: Dr. Veena Shinde (M.D, D.G.O, PG – Assisted Reproductive Technology (ART) from Warick, UK) Mumbai, India
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Author:
Khushboo Kirale
- >> Post Created: March 30, 2022
- >> Last Updated: April 19, 2024
Table of Contents - External Cephalic Version
The third trimester of pregnancy is when your baby in the womb starts getting ready for delivery. They do this by settling into the best possible position. Most babies – about 95% – settle in the head-down position, which is the best for a smooth and safe delivery.
However, there are also some cases where the baby – for some reason – adapts a malposition i.e. a breech position, transverse position or even the oblique lie.
A breech position is where the baby’s feet are toward the cervix and head is up, near the mother’s ribs according to ACOG(American College of Obstetricians and Gynecologists).This is far from the optimal position and most breech deliveries require a caesarean (C-section). It involves a few health risks for the baby and mother too.
Therefore, once the doctor finds out that the baby is in the breech position, he might suggest the ECV procedure/ External Cephalic Version procedure to try to turn the baby to the optimal birth position before labor begins.
In this article, we aim to answer the questions you may have about the ECV meaning/ ECV medical abbreviation, ECV procedure, ECV risks, ECV success rates and some Faqs on external cephalic version procedure so that you can take a more informed decision in case your doctor suggests ECV procedure.
ECV meaning – What does ECV stand for?
ECV medical abbreviation with respect to pregnancy/ What is ECV meaning in Medical terms?
ECV means External Cephalic Version in medical terms with respect to pregnancy.
ECV procedure or the External Cephalic Version procedure is a maneuver which is performed manually by medical professionals to try to turn an unborn baby who is in a breech position in the mother’s womb externally to head down position before she enters labor.
Doctors, obstetricians to be precise, use gentle, but firm pressure on certain areas of the pregnant belly to first try to turn the baby sideways and then to the optimal head-down position. They do so while continuously monitoring the baby through ultrasound.
A successful ECV procedure can make a vaginal delivery possible for the mother, avoiding a caesarean surgery.
Common ECV procedure – Facts & FAQs
• When is the ECV procedure performed?
A doctor recommends an ECV procedure only after the baby’s breech position is confirmed after 36 weeks of pregnancy.
Further the ECV procedure has to be performed before the labor begins.
• What does an ECV procedure involve?
Before beginning the ECV procedure/ External cephalic version procedure, doctors confirm that the mother and baby’s health is fine.
The ECV procedure is made of 2 major components:
- Continuous Fetal Monitoring
- Version Procedure.
The ECV procedure technique requires fetal monitoring while the version procedure is being done along with some medically administered medications for the mother. Hence an ECV procedure is generally done in a fully equipped hospital by a medical expert.
During continuous fetal monitoring, doctors need to keep a close watch on the baby through an ultrasound to avoid any harm to it. The ultrasound also helps the doctor know the placenta positioning to work the ECV procedure accordingly.
An electronic fetal heart monitoring device is also used to check for any irregularities in the heart rate.
Any irregularity in the heart rate or an irritated baby will mean the ECV procedure has to be stopped.
Before the version procedure begins, the mother-to-be is given tocolytic medicines like Terbutaline to relax the uterus.
Now, during the version procedure, the doctor will place their hands on the baby’s head and buttocks (watching through the ultrasound scan) and will slowly try to turn them, first sideways and then head-down.
In case the first ECV attempt is not successful, the doctor may suggest trying it again.
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• What to expect during the ECV procedure?
An external cephalic version procedure (ECV procedure) usually takes around 5 minutes. The obstetrician places their hand on the belly and applies appropriate pressure in the desired direction to push the baby in the optimal position.
Your baby’s heart rate is constantly monitored, as it is before and after the procedure, as there are chances that the baby gets annoyed or uncomfortable while and after the version procedure. The procedure is stopped if the baby is not responding well.
Quite a few mothers-to-be have said that the ECV procedure is uncomfortable, but medicines can be used to tackle that. In fact, some medications may improve the chances of turning the baby successfully, as they help relax the uterus and muscles.
• Is ECV procedure painful?
The main External Cephalic Version procedure takes about 5 minutes, but the pre and post procedure assessment altogether can take about 3 hours. As it is a non-invasive technique, the discomfort is only for a limited time.
However, it is vital to note that the pain sensitivity of the mother is majorly influenced by the length of the ECV procedure and the success or failure of the ECV procedure. It is seen that most women who had a longer or failed ECV procedure felt more pain.
• Is ECV procedure safe?
External cephalic version procedure is generally safe, but it does carry a few risks. Therefore, it always has to be performed in a hospital, where an emergency C-section arrangement is at hand.
Though rare, the version procedure could result in change in the baby’s heart rate or could also result in the tearing of the placenta or even trigger preterm labor.
• Does ECV procedure work for women who have had C-section previously?
Yes, as per the latest medical research, women who have had a C-section in their previous surgery/surgeries, can actually benefit by External Cephalic Version procedure in their subsequent pregnancies, with a success rate of 50%.
• Is ECV always successful - ECV success rate?
External Cephalic Version procedure has an average success rate of 58- 60% according to a study by the National Center of Biotechnology (NCBI). If the doctor is unable to turn the baby in the first attempt, they might want to attempt again after a week or so.
ECV technique can bring down the 3-4% of breech birth cases to about 1%. It is also noted that it helps in reduction of premature labor and delivery cases and in breech-related complications in babies.
There is no denying that the baby can turn back to breech position even after a successful ECV, but that is rare and the procedure can actually increase the overall chances of a normal, vaginal delivery.
However, if the baby stays in the breech position, then doctors go for a C-section. Only very experienced medical professionals may still want to try a vaginal delivery with a breech baby, but that too comes with its own risks.
Cases when ECV is NOT recommended
An ECV is a medically approved technique to try to turn the baby in an optimal position. However, in certain cases ECV can turn to be a disaster is and hence not recommended.
Your doctor will not recommend ECV if –
- The mother is expecting twins or multiple babies
- The mother has other pregnancy-related issues
- The mother’s uterus has an unusual shape. It is noted that ECV works best in case of pear-shaped uterus and not so much on heart-shaped uterus.
- The mother has other medical complications that prevent her from consuming tocolytic medicines
- The mother has had a caesarean surgery previously
- The amniotic fluid around the baby is too less or too much
- Mother has placenta previa (low-lying placenta), where the placenta is partially or fully covering the cervix
- The amniotic sac or the water bag has ruptured
- The baby has an ‘hyper-extended’ head (straight, instead of being bent forward)
- The baby has some congenital disability or other health issues
- The baby has a heart rate that is not normal
- The baby is larger than average.
Risks of ECV
The baby and its heart rate are continuously monitored while performing the external cephalic version procedure, but there are certain risks involved. Look at certain risks of ECV:
- The umbilical cord may get squeezed or twisted, affecting the blood flow and oxygen to the baby
- Amniotic sac can get ruptured, inducing labor
- Other complications that can occur during ECV, though very rare are: –
- Uterus rupture
- Placenta abruptio
- Any other kind of damage to the umbilical cord
Note
There is a minor risk that during an ECV procedure the mother can bleed and the mother’s and baby’s blood could mix. To avoid this, pregnant women with Rh-negative blood type are injected with Rh immunoglobin to avert a condition called Rh Sensitization, which can cause complications in future pregnancies.
Factors that can affect the ECV success rate
The two most important factors on which the ECV success rate depends are the skill and experience of the medical professional performing the External cephalic version and the pregnant woman’s willingness and positivity for ECV technique.
Other factors include –
- The baby has not yet got engaged in the pelvis
- The woman undergoing ECV has given birth previously
- The medical professional performing the ECV can feel the baby’s head on palpitation
In case external cephalic version does not work, your doctor can decide to attempt it once more after a week or so. However, a breech vaginal delivery is also possible, provided the doctor is very experienced and confident (though a C-section arrangement must still be done). The risks to baby’s health and life are higher in a breech vaginal delivery.
If not ECV, what other options are available to turn the baby?
There are a few exercises, movements to work on to urge the baby to turn to the optimal position.
- Expectant Management: This is based on the possibility of the conversion to a cephalic position from breech, which is said to be around 3%.
- Trial of Labor: This can be feasible option for a certain type of pregnant women, including multiparous women with a proven pelvis, a full-term fetus, and complete cervical dilation.
- ECV during labor: Attempting ECV at the beginning of labor is safe for women who have their membranes intact.
- Moxibustion and Acupuncture: This is an ancient Chinese practice in which a Chinese herb is burnt close to the mother’s acupuncture point.
- Postural maneuvers (Detailed how to do below): Pelvic elevation postures can help the baby to turn to a cephalic position. Also, hip tilts, pelvic rotations, rocking back & forth, walking, and swimming help. We suggest you discuss this with your doctor (the right methods too) before you begin.
Exercises that can help you turn your baby from breech position to head down position. However, talk to your doctor/ Obgyn before trying any of these exercises on yourself just to make sure that they are safe for you and your child.
Walking or swimming
- Walking, swimming, or engaging in any other low impact exercise.
- Do any of the above low impact exercises for 30 minutes a daily. Staying active could help your baby in moving out of the breech position.
Pelvic rotations
- First sit or stand on a birthing or exercise ball.
- Once in position, slowly and gently rotate your hips in a circular motion – clockwise. Repeat this 10 times.
- Then do the rotations 10 times counter clockwise.
- To be done 3 times a day.
Hip tilts
- First lie flat on the floor in front of a chair/sofa/seat, with feet on the seat/sofa/chair. You need to place cushions under your hips for additional support. Your body should be elevated at a 45˚ angle and hips raised around 1.5ft above your head.
- You need to be in this position for around 10 to 15 minutes. Repeat three times a day. It is advised that you do hip tilts when you feel your baby is the most active.
Rocking back and forth
- Come on your fours by Placing your hands & knees on the floor like an animal.
- While keeping your hands and knees steady in one place, gently rock your body slowly back and forth.
- You need to do this for around 15 minutes. Repeat 3 times daily.
In a nutshell
External Cephalic Version procedure (ECV procedure) is a viable option for all women who have a breech baby and no other complications.
ECV success rate is around 58% making it more than 50% effective in all cases, and hence, reduces the chances for the pregnant women to go under the knife – Breech C section – to deliver their baby.
Yes, there are risks of ECV procedure, so take your time to discuss your doubts and fears with your doctor before you go for it.
A mother who is willing and positive about the procedure helps almost as much as a skilled doctor in terms of the technique’s success rate.
Hope our article has helped you with all your queries on the external cephalic version procedure and helped you take an informed decision if you are suggested to go for same.
Keep an open mind and stay positive, that what makes all the difference at the end.
Happy Pregnancy!
Khushboo Kirale
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