Cephalic version by postural management for breech presentation (Cochrane Review)

A substantive amendment to this systematic review was last made on 10 March 2000. Cochrane reviews are regularly checked and updated if necessary.

Background: Babies with breech presentation (bottom first) are at increased risk of complications during birth, and are often delivered by caesarean section. The chance of breech presentation persisting at the time of delivery, and the risk of caesarean section, can be reduced by external cephalic version (ECV - turning the baby by manual manipulation through the mother's abdomen). It is also possible that maternal posture may influence fetal position. Many postural techniques have been used to promote cephalic version.

Objectives: The objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. Procedures in which the mother rests with her pelvis elevated were evaluated. These include the knee-chest position, and a supine position with the pelvis elevated with a wedge-shaped cushion.

Search strategy: The Cochrane Pregnancy and Childbirth Group trials register (searched September 2001) and the Cochrane Controlled Trials Register (Cochrane Library, Issue 3, 2001) were searched.

Selection criteria: Randomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group.

Data collection and analysis: Eligibility and trial quality were assessed by one or both reviewers.

Main results: Five studies involving a total of 392 women were included. No effect of postural management on the rate non-cephalic births was detected, either for the subgroup in which no external cephalic version was attempted, or for the group overall (relative risk 0.95, 95% confidence interval 0.81 to 1.11). No differences were detected for caesarean sections or Apgar scores below seven at one minute.

Reviewers' conclusions: There is insufficient evidence from well-controlled trials to support the use of postural management for breech presentation. The numbers of women studied to date remain relatively small. Further research is needed.

Citation: Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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