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<div class="mw-indicators"> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Process by which a breech baby can sometimes be turned from buttocks or foot first to head first</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical intervention</div> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: lightblue">External cephalic version</th></tr><tr><td colspan="2" class="infobox-image"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:As_tabula_IX_and_Child_presenting_feet_Wellcome_L0009819.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7a/As_tabula_IX_and_Child_presenting_feet_Wellcome_L0009819.jpg/280px-As_tabula_IX_and_Child_presenting_feet_Wellcome_L0009819.jpg" decoding="async" width="280" height="497" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7a/As_tabula_IX_and_Child_presenting_feet_Wellcome_L0009819.jpg/420px-As_tabula_IX_and_Child_presenting_feet_Wellcome_L0009819.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7a/As_tabula_IX_and_Child_presenting_feet_Wellcome_L0009819.jpg/560px-As_tabula_IX_and_Child_presenting_feet_Wellcome_L0009819.jpg 2x" data-file-width="1031" data-file-height="1829" /></a></span><div class="infobox-caption">Child presenting head first (top) and feet first (bottom)<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/ICD-9-CM_Volume_3" title="ICD-9-CM Volume 3">ICD-9-CM</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="http://icd9cm.chrisendres.com/index.php?srchtype=procs&srchtext=73.91&Submit=Search&action=search">73.91</a></td></tr><tr class="noprint"><td colspan="2" class="infobox-full-data"><div style="text-align: right;">[<a href="https://www.wikidata.org/wiki/Q258285" class="extiw" title="d:Q258285">edit on Wikidata</a>]</div></td></tr></tbody></table> <p><b>External cephalic version</b> (<b>ECV</b>) is a process by which a <a href="/wiki/Breech_birth" title="Breech birth">breech baby</a> can sometimes be turned from buttocks or foot first to head first. It is a manual procedure that is recommended by national guidelines for <a href="/wiki/Breech_birth" title="Breech birth">breech</a> presentation of a pregnancy with a single baby, in order to enable <a href="/wiki/Vaginal_delivery" title="Vaginal delivery">vaginal delivery</a>.<sup id="cite_ref-:Sharoni2015_2-0" class="reference"><a href="#cite_note-:Sharoni2015-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-StatPearls_3-0" class="reference"><a href="#cite_note-StatPearls-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> It is usually performed late in pregnancy, that is, after 36 <a href="/wiki/Gestational_age_(obstetrics)" class="mw-redirect" title="Gestational age (obstetrics)">gestational weeks</a>,<sup id="cite_ref-RCOG2017_4-0" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> preferably 37 weeks,<sup id="cite_ref-ArnoldFlint2017_5-0" class="reference"><a href="#cite_note-ArnoldFlint2017-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> and can even be performed in the early stages of childbirth.<sup id="cite_ref-RCOG2017_4-1" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>ECV is endorsed by the <a href="/wiki/American_College_of_Obstetricians_and_Gynecologists" title="American College of Obstetricians and Gynecologists">American College of Obstetricians and Gynecologists</a> (ACOG) and <a href="/wiki/Royal_College_of_Obstetricians_and_Gynaecologists" title="Royal College of Obstetricians and Gynaecologists">Royal College of Obstetricians and Gynaecologists</a> (RCOG) as a mode to avoid the risks associated with a vaginal breech or <a href="/wiki/Cesarean_delivery" class="mw-redirect" title="Cesarean delivery">cesarean delivery</a> for singleton breech presentation.<sup id="cite_ref-:Sharoni2015_2-1" class="reference"><a href="#cite_note-:Sharoni2015-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_6-0" class="reference"><a href="#cite_note-:0-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>ECV can be contrasted with "internal cephalic version", which involves a hand inserted through the <a href="/wiki/Cervix" title="Cervix">cervix</a>.<sup id="cite_ref-pmid13669146_7-0" class="reference"><a href="#cite_note-pmid13669146-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Medical_use">Medical use</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=1" title="Edit section: Medical use"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>ECV is one option of intervention should a breech position of a baby be found after 36 weeks gestation. Other options include a planned caesarian section or planned vaginal delivery.<sup id="cite_ref-RCOG2017_4-2" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Success_rates">Success rates</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=2" title="Edit section: Success rates"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>ECV has an average success rate of around 58%,<sup id="cite_ref-StatPearls_3-1" class="reference"><a href="#cite_note-StatPearls-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> between 40 and 64% depending on whether it is the mother's first child or not. (40% for first-time mothers and closer to 60% for women who have had previous children.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (April 2020)">citation needed</span></a></i>]</sup> </p><p>Various factors can alter the success rates of ECV. Practitioner experience, maternal weight, obstetric factors such as uterine relaxation, a palpable fetal head, a non-engaged breech, non-anterior placenta, and an amniotic fluid index above 7–10 cm, are all factors which can be associated with higher success rates. In addition, the effect of <a href="/wiki/Neuraxial_blockade" title="Neuraxial blockade">neuraxial blockade</a> on ECV success rates have been conflicting, although ECV appears easier to perform under <a href="/wiki/Epidural_block" class="mw-redirect" title="Epidural block">epidural block</a>.<sup id="cite_ref-:Sharoni2015_2-2" class="reference"><a href="#cite_note-:Sharoni2015-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>Following successful ECV, with the baby turned to head first, there is a less than 5% chance of the baby turning spontaneously to breech again.<sup id="cite_ref-rcog2010_9-0" class="reference"><a href="#cite_note-rcog2010-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Contra-indications">Contra-indications</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=3" title="Edit section: Contra-indications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some situations exist where ECV is not indicated or may cause harm. These include recent <a href="/wiki/Antepartum_haemorrhage" class="mw-redirect" title="Antepartum haemorrhage">antepartum haemorrhage</a>, <a href="/wiki/Placenta_praevia" title="Placenta praevia">placenta praevia</a>, abnormal fetal monitoring, <a href="/wiki/Ruptured_membranes" class="mw-redirect" title="Ruptured membranes">ruptured membranes</a>, <a href="/wiki/Multiple_pregnancy" class="mw-redirect" title="Multiple pregnancy">multiple pregnancy</a>, <a href="/wiki/Pre-eclampsia" title="Pre-eclampsia">pre-eclampsia</a>, <a href="/wiki/Oligohydramnios" title="Oligohydramnios">reduced amniotic fluid</a> and some other abnormalities of the uterus or baby.<sup id="cite_ref-rcog2010_9-1" class="reference"><a href="#cite_note-rcog2010-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Risks">Risks</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=4" title="Edit section: Risks"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As with any procedure there can be complications most of which can be greatly decreased by having an experienced professional on the birth team. An <a href="/wiki/Ultrasound" title="Ultrasound">ultrasound</a> to estimate a sufficient amount of amniotic fluid and monitoring of the fetus immediately after the procedure can also help minimize risks.<sup id="cite_ref-Kok2009_10-0" class="reference"><a href="#cite_note-Kok2009-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>Evidence of complications of ECV from clinical trials is limited, but ECV does reduce the chance of breech presentation at birth and caesarian section. The 2015 <i>Cochrane review</i> concluded that "large observational studies suggest that complications are rare".<sup id="cite_ref-rcog2010_9-2" class="reference"><a href="#cite_note-rcog2010-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-CochraneReview2015_11-0" class="reference"><a href="#cite_note-CochraneReview2015-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Typical risks include <a href="/w/index.php?title=Umbilical_cord_entanglement&action=edit&redlink=1" class="new" title="Umbilical cord entanglement (page does not exist)">umbilical cord entanglement</a>, <a href="/wiki/Placental_abruption" title="Placental abruption">abruption of placenta</a>, preterm labor, <a href="/wiki/Premature_rupture_of_the_membranes" class="mw-redirect" title="Premature rupture of the membranes">premature rupture of the membranes</a> (PROM) and severe maternal discomfort. Overall complication rates have ranged from about 1 to 2 percent since 1979. While somewhat out of favour between 1970 and 1980, the procedure has seen an increase in use due to its relative safety.<sup id="cite_ref-Coco1998_12-0" class="reference"><a href="#cite_note-Coco1998-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>Successful ECV significantly decreases the rate of cesarean section, however, women are still at an increased risk of instrumental delivery (<a href="/wiki/Ventouse" class="mw-redirect" title="Ventouse">ventouse</a> and <a href="/wiki/Forceps_delivery" class="mw-redirect" title="Forceps delivery">forceps delivery</a>) and cesarean section compared to women with spontaneous cephalic presentation (head first).<sup id="cite_ref-RCOG2017_4-3" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Technique">Technique</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=5" title="Edit section: Technique"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The procedure is undertaken by either one or two physicians and where emergency facilities to undertake instrumental delivery and caesarian section are at hand. Blood is also taken for <a href="/wiki/Cross-matching" title="Cross-matching">cross-matching</a> should a complication arise.<sup id="cite_ref-Coco1998_12-1" class="reference"><a href="#cite_note-Coco1998-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Prior to performing ECV, an <a href="/wiki/Ultrasound" title="Ultrasound">ultrasound</a> of the abdomen is performed to confirm the breech position and the mother's blood pressure and pulse are taken. A <a href="/wiki/Cardiotocography" title="Cardiotocography">cardiotocography</a> (CTG) is also performed to monitor the baby's heart.<sup id="cite_ref-RCOG2017_4-4" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p>The procedure usually lasts a few minutes and is monitored intermittently with CTG.<sup id="cite_ref-:0_6-1" class="reference"><a href="#cite_note-:0-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> With a covering of <a href="/wiki/Lubricant" title="Lubricant">ultrasonic gel</a> on the abdomen to reduce friction,<sup id="cite_ref-Coco1998_12-2" class="reference"><a href="#cite_note-Coco1998-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> the physician's hands are placed on the mother's <a href="/wiki/Abdomen" title="Abdomen">abdomen</a> around the baby. Then, by applying firm pressure to manoeuvre the baby up and away from the <a href="/wiki/Human_pelvis" class="mw-redirect" title="Human pelvis">pelvis</a> and to gently turn in several steps from breech, to a sideways position, the final manipulation results in a head first presentation.<sup id="cite_ref-RCOG2017_4-5" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> The procedure is discontinued if maternal distress, repeated failure or <a href="/wiki/Fetal_distress" title="Fetal distress">fetal compromise</a> on monitoring occurs.<sup id="cite_ref-Coco1998_12-3" class="reference"><a href="#cite_note-Coco1998-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>ECV performed before term may decrease the rate of breech presentation compared to ECV at term, but may increase the risk of <a href="/wiki/Preterm_delivery" class="mw-redirect" title="Preterm delivery">preterm delivery</a>.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> There is some evidence to support the use of <a href="/wiki/Tocolytic" title="Tocolytic">tocolytic</a> drugs in ECV.<sup id="cite_ref-Cluver2015_17-0" class="reference"><a href="#cite_note-Cluver2015-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Given by injection, tocolytics relax the uterus muscle and may improve the chance of turning the baby successfully. This is considered safe for the mother and baby, but can cause the mother to experience <a href="/wiki/Flushing_(physiology)" title="Flushing (physiology)">facial flushing</a> and a feeling of a <a href="/wiki/Palpitations" title="Palpitations">fast heart rate</a>.<sup id="cite_ref-RCOG2017_4-6" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Use of intravenous <a href="/wiki/Nitroglycerin" title="Nitroglycerin">nitroglycerin</a> has been proposed.<sup id="cite_ref-pmid19701035_18-0" class="reference"><a href="#cite_note-pmid19701035-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>Following the procedure, a repeat CTG is performed and a repeat ultrasound will confirm a successful turn.<sup id="cite_ref-RCOG2017_4-7" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Should this first attempt fail, a second attempt on another day can be considered.<sup id="cite_ref-rcog2010_9-3" class="reference"><a href="#cite_note-rcog2010-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>In addition, to prevent <a href="/wiki/Rh_disease" title="Rh disease">Rh disease</a> after the procedure, all <a href="/wiki/Rh_blood_group_system" title="Rh blood group system">rhesus D negative</a> pregnant women are offered an <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">intramuscular injection</a> of anti-Rh antibodies (<a href="/wiki/Rho(D)_immune_globulin" title="Rho(D) immune globulin">Rho(D) immune globulin</a>).<sup id="cite_ref-RCOG2017_4-8" class="reference"><a href="#cite_note-RCOG2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=6" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>ECV has existed since 384–322 B.C., the time of <a href="/wiki/Aristotle" title="Aristotle">Aristotle</a>.<sup id="cite_ref-Coco1998_12-4" class="reference"><a href="#cite_note-Coco1998-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Around 100 A.D., <a href="/wiki/Soranus_of_Ephesus" title="Soranus of Ephesus">Soranus of Ephesus</a> included guidance on ECV as a way to reduce complications of vaginal breech birth. 17th century French obstetrician, <a href="/wiki/Fran%C3%A7ois_Mauriceau" title="François Mauriceau">François Mauriceau</a>, is alleged to have described ECV as "a little more difficult than turning an omelette in a frying pan".<sup id="cite_ref-:Paul2017_19-0" class="reference"><a href="#cite_note-:Paul2017-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Justus_Heinrich_Wigand" title="Justus Heinrich Wigand">Justus Heinrich Wigand</a> published an account of ECV in 1807 and the procedure was increasingly accepted following <a href="/wiki/Adolphe_Pinard" title="Adolphe Pinard">Adolphe Pinard</a>'s demonstration of it in France. In 1901, British obstetrician, <a href="/wiki/Herbert_R._Spencer" title="Herbert R. Spencer">Herbert R. Spencer</a>, advocated ECV in his publication on breech birth. In 1927, obstetrician George Frederick Gibberd, reviewed 9,000 consecutive births around <a href="/wiki/Guy%27s_Hospital" title="Guy's Hospital">Guy's Hospital</a>, London. Following his study, he recommended ECV, even if it failed and needed to be repeated and even if it required <a href="/wiki/Anaesthesia" class="mw-redirect" title="Anaesthesia">anaesthesia</a>.<sup id="cite_ref-:Paul2017_19-1" class="reference"><a href="#cite_note-:Paul2017-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>ECV's safety has continued to be a longstanding controversy. Following a protocol developed in Berlin, ECV did increase in popularity in the United States in the 1980s.<sup id="cite_ref-Coco1998_12-5" class="reference"><a href="#cite_note-Coco1998-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> The procedure has been increasingly considered as low risk of complications and its improvement in safety as a result of the routine use of electronic fetal monitoring, waiting until closer to term and the replacement of anaesthesia by tocolysis,<sup id="cite_ref-:Paul2017_19-2" class="reference"><a href="#cite_note-:Paul2017-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> has seen a recent resurgence.<sup id="cite_ref-:0_6-2" class="reference"><a href="#cite_note-:0-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=7" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFBurton1751" class="citation web cs1">Burton, John (1751). <a rel="nofollow" class="external text" href="http://catalogue.wellcomelibrary.org/record=b1070675">"An essay towards a complete new system of midwifry, theoretical and practical. 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title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstet+Gynecol&rft.atitle=Intravenous+nitroglycerin+for+external+cephalic+version%3A+a+randomized+controlled+trial&rft.volume=114&rft.issue=3&rft.pages=560-7&rft.date=2009-09&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A9757809%23id-name%3DS2CID&rft_id=info%3Apmid%2F19701035&rft_id=info%3Adoi%2F10.1097%2FAOG.0b013e3181b05a19&rft.aulast=Hilton&rft.aufirst=J&rft.au=Allan%2C+B&rft.au=Swaby%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AExternal+cephalic+version" class="Z3988"></span><span style="font-size:0.95em; font-size:95%; color: var( --color-subtle, #555 )">(subscription required)</span></span> </li> <li id="cite_note-:Paul2017-19"><span class="mw-cite-backlink">^ <a href="#cite_ref-:Paul2017_19-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:Paul2017_19-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:Paul2017_19-2"><sup><i><b>c</b></i></sup></a></span> 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class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28328063">28328063</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BJOG%3A+An+International+Journal+of+Obstetrics+%26+Gynaecology&rft.atitle=The+baby+is+for+turning%3A+external+cephalic+version&rft.volume=124&rft.issue=5&rft.pages=773&rft.date=2017-03-22&rft.issn=1470-0328&rft_id=info%3Apmid%2F28328063&rft_id=info%3Adoi%2F10.1111%2F1471-0528.14238&rft.aulast=Paul&rft.aufirst=Carolyn&rft_id=https%3A%2F%2Fdoi.org%2F10.1111%252F1471-0528.14238&rfr_id=info%3Asid%2Fen.wikipedia.org%3AExternal+cephalic+version" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=External_cephalic_version&action=edit&section=8" title="Edit section: External links"><span>edit</span></a><span 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title="Pregnancy">pregnancy</a> and <a href="/wiki/Childbirth" title="Childbirth">childbirth</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Maternal tests</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pregnancy_test" title="Pregnancy test">Pregnancy test</a></li> <li><a href="/wiki/Leopold%27s_maneuvers" title="Leopold's maneuvers">Leopold's maneuvers</a></li> <li><a href="/wiki/Prenatal_testing" title="Prenatal testing">Prenatal testing</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Fetal tests</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Imaging</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Obstetric_ultrasonography" title="Obstetric ultrasonography">Obstetric ultrasonography</a> <ul><li><a href="/wiki/Nuchal_scan" title="Nuchal scan">Nuchal scan</a></li> <li><a href="/wiki/Anomaly_scan" title="Anomaly scan">Anomaly scan</a></li> <li><a href="/wiki/Crown-rump_length" title="Crown-rump length">Crown-rump length</a></li></ul></li> <li><a href="/wiki/Fetal_movement#Monitoring_fetal_movement" title="Fetal movement">Fetal movement counting</a></li> <li><a href="/wiki/Contraction_stress_test" title="Contraction stress test">Contraction stress test</a></li> <li><a href="/wiki/Nonstress_test" title="Nonstress test">Nonstress test</a></li> <li><a href="/wiki/Vibroacoustic_stimulation" title="Vibroacoustic stimulation">Vibroacoustic stimulation</a></li> <li><a href="/wiki/Biophysical_profile" title="Biophysical profile">Biophysical profile</a> <ul><li><a href="/wiki/Amniotic_fluid_index" title="Amniotic fluid index">Amniotic fluid index</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Sampling</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chorionic_villus_sampling" title="Chorionic villus sampling">Chorionic villus sampling</a></li> <li><a href="/wiki/Amniocentesis" title="Amniocentesis">Amniocentesis</a></li> <li><a href="/wiki/Triple_test" title="Triple test">Triple test</a></li> <li><a href="/wiki/Triple_test#Quadruple_test" title="Triple test">Quad test</a></li> <li><a href="/wiki/Fetoscopy" title="Fetoscopy">Fetoscopy</a></li> <li><a href="/wiki/Fetal_scalp_blood_testing" title="Fetal scalp blood testing">Fetal scalp blood testing</a></li> <li><a href="/wiki/Fetal_scalp_stimulation_test" title="Fetal scalp stimulation test">Fetal scalp stimulation test</a></li> <li><a href="/wiki/Percutaneous_umbilical_cord_blood_sampling" title="Percutaneous umbilical cord blood sampling">Percutaneous umbilical cord blood sampling</a></li> <li><a href="/wiki/Alkali_denaturation_test" title="Alkali denaturation test">Apt test</a></li> <li><a href="/wiki/Kleihauer%E2%80%93Betke_test" title="Kleihauer–Betke test">Kleihauer–Betke test</a></li> <li>Lung maturity <ul><li><a href="/wiki/Lecithin%E2%80%93sphingomyelin_ratio" title="Lecithin–sphingomyelin ratio">Lecithin–sphingomyelin ratio</a></li> <li><a href="/wiki/Lamellar_body_count" title="Lamellar body count">Lamellar body count</a></li> <li><a href="/wiki/Fetal_fibronectin" title="Fetal fibronectin">Fetal fibronectin test</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiotocography" title="Cardiotocography">Cardiotocography</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Interventions</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Fetal_surgery" title="Fetal surgery">Fetal surgery</a></li> <li><a href="/wiki/Fetendo" title="Fetendo">Fetendo</a></li> <li><a href="/wiki/Podalic_version" title="Podalic version">Podalic version</a> <ul><li><a class="mw-selflink selflink">External cephalic version</a></li></ul></li> <li><a href="/wiki/Amnioinfusion" title="Amnioinfusion">Amnioinfusion</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Childbirth" title="Childbirth">Delivery</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vaginal_delivery" title="Vaginal delivery">Vaginal delivery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Labor_induction" title="Labor induction">Induction</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Operative_vaginal_delivery" title="Operative vaginal delivery">Assisted vaginal delivery</a></li> <li><a href="/wiki/Artificial_rupture_of_membranes" title="Artificial rupture of membranes">Artificial rupture of membranes</a></li> <li><a href="/wiki/Episiotomy" title="Episiotomy">Episiotomy</a></li> <li><a href="/wiki/Symphysiotomy" title="Symphysiotomy">Symphysiotomy</a></li> <li><a href="/wiki/Obstetrical_forceps" title="Obstetrical forceps">Obstetrical forceps</a></li> <li><a href="/wiki/Vacuum_extraction" title="Vacuum extraction">Vacuum extraction</a></li> <li><a href="/wiki/Odon_device" title="Odon device">Odon device</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Shoulder_dystocia#Procedures" title="Shoulder dystocia">Dystocia management</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/McRoberts_maneuver" title="McRoberts maneuver">McRoberts maneuver</a></li> <li><a href="/wiki/Wood%27s_screw_maneuver" title="Wood's screw maneuver">Wood's screw maneuver</a></li> <li><a href="/wiki/Zavanelli_maneuver" title="Zavanelli maneuver">Zavanelli maneuver</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Childbirth#Third_stage:_placenta_delivery" title="Childbirth">Third stage of labor</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Placenta_expulsion#Manual_placenta_removal" class="mw-redirect" title="Placenta expulsion">Manual placenta removal</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Caesarean_section" title="Caesarean section">Caesarean section</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Caesarean_section" title="Caesarean section">Elective</a></li> <li><a href="/wiki/Caesarean_delivery_on_maternal_request" title="Caesarean delivery on maternal request">On maternal request</a></li> <li><a href="/wiki/EXIT_procedure" title="EXIT procedure">EXIT procedure</a></li> <li><a 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