ABSTRACT
In order to determine the impact of external cephalic version [ECV] at term on breech presentation in terms of success rate, factors affecting success, patient acceptance and mode of delivery with a view to improve the service were studied. A retrospective review of all women with singleton breech presentation at term seen in the obstetric clinic, Tawam Hospital, United Arab Emirates between Jan. 2003 to Dec. 2003 was carried out. One hundred and seven women were identified, but only 82 were suitable for ECV when they were seen in the labour and delivery after excluding patients with spontaneous reversion, delivery prior to the appointment for ECV and patients with exclusion criteria. F4fty five out of 82 [67%] eligible women agreed to have an attempt at ECV The overall success rate was 47%. There were no adverse outcomes. Successful version was related to maternal parity but did not depend on gestational age [37-42 wks] or foetal weight. Engagement of the breech and reduced amniotic fluid [amniotic fluid index<5 cm.] were associated with failure. When version failed, trial of vaginal breech was offered after appropriate counseling and strict evaluation. The caesarean section rate in the successful group was 4% with 96% of women having vaginal delivery. In marked contrast, caesarean section rate was 89% in the unsuccessful group of which two thirds were planned and in the group where ECV was not attempted the rate was 63%. The overall assisted vaginal breech rate was 14%. This review has assisted us in making important conclusions regarding future services. This has clearly shown the reduction in caesarean section due to breech presentation and this is especially important in our culture with multiparous population where operative delivery is generally unacceptable. As the trend for assisted vaginal breech delivery is generally decreasing, ECV is the only safe option to reduce the rising caesarean rate for breech presentation and the need for repeat caesarean