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External Cephalic Version (ECV)


Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

External cephalic version (ECV) involves external manipulation on the mother's abdomen to convert a breech to a cephalic presentation.



Figure 1. The right hand lifts the breech out of the pelvis. The left hand makes the head follow the nose. Flexion of the head and back is maintained throughout.


Figure 2. Flexion is continued. The left hand brings the head downwards. The right hand pushes the breech upwards.

Figure 3. Pressure is exerted on head and breech simultaneously until the head is lying at the pelvic brim. The use of external manipulation on the pregnant woman's abdomen to convert a breech (or transverse) to a cephalic presentation.

ECV may be offered at term but should only be undertaken in a unit where there are facilities for emergency delivery. Contraindications include:

  • Pre-eclampsia or hypertension
  • Multiple pregnancy
  • Oligohydramnios (too little amniotic fluid)
  • Ruptured membranes
  • A hydrocephalic fetus
  • Any condition that would require delivery by Caesarean section

Further reading

Royal College of Obstetricians & Gynaecologists Guideline (2006, reviewed 2010) No 20a. External cephalic version and reducing the incidence of breech presentation. Available at:


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