External Cephalic Version (ECV) and the Early ECV Trial

The Caesarean section rate among women with breech pregnancies at term is approximately 70 percent. External cephalic version (ECV) has a recognized role in decreasing the likelihood of Caesarean section in women with breech pregnancies. External cephalic version prior to 37 weeks gestation has been abandoned in favour of initiating ECV ator after 37 weeks, with or without the use of tocolytic medication to facilitate the procedure. In North America andEurope, when the manoeuvre is undertaken at or after 37 weeks gestation, therate of successful version resulting in a cephalic presentation at the time of delivery has remained low, particularly amongst nulliparous women. There is increasing interest in beginning ECV as early as 34 weeks gestation for selected women, as an approach to decreasing the overall rate of non-cephalic presentations at term. The Early ECV Trial is a multicentred, randomized controlled trial comparing the selective use of ECV beginning at 34 weeks gestation to ECV after 37 weeks. The primary outcome is the rate of non-cephalic presentation at the time of birth. Collaborators in the Early ECV Trial include midwives and obstetricians from Toronto, Scarborough, Mississauga, Calgary, Ottawa, Thunder Bay and Hamilton.