External cephalic version after 36th week of gestation
Analysis of women´s perspective

Authors: K. Wágnerová;  L. Hruban;  P. Janků
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in: Ceska Gynekol 2017; 82(5): 355-361


Evaluation of opinions and subjective feelings of patients who have undergone an external cephalic version of a fetus in breech presentation after the 36th week of pregnancy.

Observational analytic cohort study.

Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno.

Materials and methods:
We collected opinions and subjective evaluation from pregnant women who underwent an attempt of external cephalic version at the department of Gynecology and Obstetrics, Masaryk University in Brno in the period from 1st January 2015 to 31st December 2016 through a questionnaire. The questionnaire contained a total of 10 dichotomous, sampling, enumeration and scale questions. Questions were focused on the source and type of information on external cephalic version, expectations of the patients, evaluation of pain and feelings during the procedure and the overall impression. We also evaluated the differences between answers from patients after a successful and an unsuccessful version.

In reported period 205 pregnant women underwent an attempt of external cephalic version. Procedure was successful in 105 (51.2%) cases of which 81 (77.1%) subsequently gave birth vaginally, 24 (22.9%) delivered by caesarean section, 10 (9.5%) out of all patients delivered in other hospitals. The total number of fully completed questionnaires was 187 (after a successful version 98 and 89 after an unsuccessful version). The most common source of information about the procedure was given to the patients from their gynecologists (40.5%) and doctors at the ambulance in the hospital where the patients are sent before delivery by their gynecologists (27.9%). Most mothers received mostly positive information (70.5%) – increased likelihood of vaginal delivery, high success rate, low risk to mother and child. Attitude of the gynecologists on the external cephalic version was positive in 52.6% and they recommended it. 14.4% of the patients had no fear before the procedure, 61% patients were nervous and 23% had fear. For 30.5% of the respondents was the version worse than expected. 33.7% of the patients expected that the procedure would be worse and for 35.8% of the women the procedure fulfilled their expectations. 42.2% of all patients rated the pain level on a scale from 0 (no pain) to 10 (maximum pain) in the range of 4–6 points, 28.9% evaluated the pain under 4 points and 28.9% over 6 points. Among other unpleasant feelings associated with external cephalic version were most frequently mentioned: nausea (15.9%), fear (39.8%), distress (7.5%). One-third of respondents, however, experienced no negative feelings (33.8%). 80.2% of the patients did not have any problems after the version. Out of all respondents 89.3% would undergo the procedure again and recommend it to others. Overall satisfaction rating on a scale from 0 (completely dissatisfied) to 5 (very satisfied) was 89.8% in the range from 4 to 5. When comparing the answers of patients after an external cephalic version there was no significant difference depending on the success of the version.

The results show that the main source of information is given to the patients by their gynecologists and doctors in the hospital who recommend the procedure and significantly affect the attitude of patients towards external cephalic version. Fear and nervousness of the mothers is usually unfounded, most of the women evaluate the procedure positively and would recommend it to another pregnant women even in case of an unsuccessful attempt. Pain during the procedure is for most women bearable and in the overall ranking does not mean a significant problem.

external cephalic version, breech presentation, pateint´s evaluation and attitude


1. Balayla, J., Dahdouh, EM., Villeneuve, S., et al. Obstetrical and neonatal outcomes following unsuccessful external cephalic version: a stratified analysis amongst failures, successes, and controls. J Matern Fetal Neonatal Med, 2015, 28(5), p. 605–610.

2. Beuckens, A., Rijnders, M., Verburgt-Doeleman, GHM., et al. An observational study of the success and comlications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwifes. BJOG, 2016,123, p. 415–423.

3. Burgos, J., Cobos, P., Osuba, C., et al. Nitrous oxide for analgesia in external cephalic version at term: prospective comparative study. J Perinatal Med, 2013, 41(6), p. 719–723.

4. Ciliacus, E., vad de Zalm, M., Truijens, S., et al. Fear for external cephalic version and depression: predictors of successful external cephalic version for breech presentation at term? BMC Pregnancy and Childbirth, 2014, 14, p. 101.

5. Chong, ES., Mongelli, M. Attitudes of Singapore women toward ceasarean and vaginal deliveries. Int J Gynaecol Obstet, 2003, 80(2), p. 189–194.

6. Collaris, RJ., Oei, SG. External cephalic version: A safe procedure? A systematic review of version related risks. Acta Obstet Gynecol Scand, 2004, 83(6), p. 511–518.

7. Ebner, F., Friedl, T., Leinert, E., et al. Predictors for a successful external cephalic version: a single centre experience. Arch Gynaecol Obstet, 2016, 193, p. 749–755.

8. Fok, WY., Chan, LW., Leung, TY., et al. Maternal experience of pain during external cephalic version at term. Acta Obstet Gynecol Scand, 2005, 84(4), p. 748–751.

9. Hannah, ME., Hannah,WJ., Hewson, SA., et al. Planned ceasarean section versus planned vaginal birth for breech presentation, at term: a randomised multicenter trial. Term Breech Trial Collaborative Group. Lancet, 2000, 356, p. 1375–1383.

10. Hofmeyr, GJ., Kulier, R. External cephalic version for breech presentation at term. Cochrane Database Syst Rev., 2000, 2, CD000083.

11. Hofmeyr, GJ., Kulier, R. External cephalic version for breech presentation at term. Cochrane Database of Syst Rev., 2012, 10, CD000083.

12. Hutton, EK., Hofmeyr, GJ. External cephalic version for breech presentation at term. Cochrane database Syst Rev., 2006, 1, CD000084.

13. Kok, M., Cnossen, J., Gravendeek, L., et al. Clinical factors to predict the outcome of external cephalic version: A meta analysis. As J Obstet Gynecol 2008, 199(6), p. 630–637.

14. Kotaska, A. Breech birth can be safe, but is it worth the effort? J Obstet Gynaecol Can, 2009, 31(6), p. 553–554.

15. Leung, TY., Lau, TK., Lo, KW., et al. A survey of pregnant women´s attitude towards breech delivery and external cephalic version. Aust N Z J Obstet Gynaecol, 2000, 40(3), p. 253–259.

16. Nagy, J., Nyklova, E. Jsou obavy z obratu zevními hmaty oprávněné? Čes Gynek, 2008, 73(4), s. 254–260.

17. Nasar, N., Roberts, CL., Barratt, A., et al. Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term. Paediatr Perinat Epidem, 2006, 20(2), p. 163–171.

18. Raynes-Greenow, CH., Roberts, CL., Barratt, A., et al. Pregnant women´s preferences and knowledge of term breech management, in Australian setting. Midwifery 2004, 20(2), p. 181–187.

19. Reinhard, J., Heinrich, TM., Reitter, A., et al. Clinical hypnosis before external cephalic version. Am J Clin Hypn, 2012, 55(2), p. 184–192.

20. Rijnders, M., Offerhaus, P.,van Dommelen, P., et al. Prevalence, outcome,and women´s experience of external cephalic version in low-risk population. Birth: Issue in Perinatal Care, 2010, 37(2), p. 124–133.

21. Rodgers, R., Beik, N., Nassar, N., et al. Complication of external cephalic version: a retrospective analysis of 1121 patients at tertiary hospital Sydney. BJOG, 2016, 124(5), p. 767–772.

22. Say, R., Thomson, R., Robson, S., et al. A qualitative interview study exploring pregnant women´s and health professional´s attitudes to external cephalic version. BMC Pregnancy and Childbirth, 2013, 13(1), p. 1–9.

23. Smaga, D., Cheseaux, N., Forster, A., et al. Hypnosis and anxiety problems. Rev Med Suisse, 2010, 6, p. 830–834.

24. Theron, GB., Kader, R. Obstetric outcome after successful external cephalic version for breech presentation at term. Int J Gynaecol Obstet, 2014, 127(3), p. 298–299.

25. Velzel, J., de Hundt, M., Mulder, FM. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol, 2015, 195, p. 160–167.

26. Vlemmix, F., Kuitert, M., Bais, S., et al. Patient‘s willingness to opt for external cephalic version. J Psychosom Obstet Gynaecol, 2013, 34(1), p. 15–21.

27. Watts, NP., Petrovska, K., Bisits, A. This baby is not for turning: Women´s experiences of attempted external cephalic version. BMC Pregnancy and Childbirth, 2016, 16, p. 248–253.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 5

2017 Issue 5

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account