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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.
Version is done most often before labor begins, typically around 36 to 37 weeks. Version is sometimes used during labor before the amniotic sac has ruptured. This can be a good time to use version, when labor is constantly monitored and a cesarean delivery (C-section) can be done right away if needed. But the chance to do the version can be lost if labor speeds up or the amniotic sac ruptures.
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 terbutaline.
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.1
Serious 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 when:
Version is usually not done when:
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.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%.2 Version is most likely to succeed when:3
Version is least likely to succeed when: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.
Potential risks of version, for which the fetus and mother are closely monitored, include:
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. To learn more, see the topic Rh Sensitization During Pregnancy.
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 the uterus.
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CitationsKlatt 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 2009). 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.
Last Revised: July 25, 2011
Author: Healthwise Staff
Medical Review: Sarah Marshall, MD - Family Medicine & William Gilbert, MD - Maternal and Fetal Medicine
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