About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024
ISSN 0300-9092 (Print)
ISSN 2412-5679 (Online)
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024
Logout
Obstetrics and Gynegology2026№6

External cephalic version in modern obstetrics

DOI
https://dx.doi.org/10.18565/aig.2026.87

Babich D.A., Baev O.R., Ivanova E.D.

1) Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 2) I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia

The issue of breech presentation remains relevant due to ongoing debate regarding methods of correction and the mode of delivery. Vaginal delivery of a breech baby is associated with higher rates of perinatal morbidity and mortality compared with caesarean section for breech presentation. It is clinically important to confirm breech presentation at 36 weeks’ gestation and to inform the patient about the risks associated with breech delivery, the medical interventions that can reduce these risks, and possible modes of delivery, and their complications. In recent years, an increasing number of studies have appeared in the international scientific literature reporting that external cephalic version (when considering indications and contraindications) is an effective and safe alternative to breech delivery, whether vaginal delivery or caesarean section.
Conclusion. External cephalic version is a relatively simple, non‑invasive procedure with a low risk of complications, and it can reduce the incidence of complications associated with breech delivery. The use of tocolytics during external cephalic version is recommended for all women who have no contraindications. Regional analgesia is the method of choice for external cephalic version; however, it should be administered according to individual indications (failure of the first attempt due to poor tolerance of the procedure, pain, involuntary tension of the abdominal muscles). The procedure of external cephalic version offers significant cost‑effectiveness by reducing the rate of caesarean sections, which in turn improves the prospects for future deliveries.

Authors’ contributions. Baev O.R., Babich D.A. – developing the concept of the study, editing the article; Babich D.A., Ivanova E.D. – review of publications on the subject of the article, writing the text.
Conflicts of interest. The authors declare that there are no conflicts of interest.
Funding. The study was conducted without sponsorship.
Generative Artificial Intelligence. No artificial intelligence tools were used in the preparation of this manuscript.
For citation: Babich D.A., Baev O.R., Ivanova E.D. External cephalic version in modern obstetrics.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (6): 14-20 (in Russian)
https://dx.doi.org/10.18565/aig.2026.87

Keywords

breech presentation
external cephalic version
breech delivery
cesarean section
Full text (in Russian)

References

  1. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Тазовое предлежание плода. М.; 2024. 33 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Pelvic previa. Moscow; 2024. 33 p. (in Russian)].
  2. Серов В.Н., Сухих Г.Т., Курцер М.А., Радзинский В.Е., ред. Акушерство. Национальное руководство. 3-е изд., испр. и доп. М.: ГЭОТАР-Медиа; 2026. 1048 с. [Serov V.N., Sukhikh G.T., Kurtser M.A., Radzinsky V.E., eds. Obstetrics. National guide. 3rd ed. Moscow: GEOTAR-Media; 2026. 1048 p. (In Russian)].
  3. Cobec I.M., Varzaru V.B., Kövendy T., Kuban L., Eftenoiu A.E., Moatar A.E. et al. External cephalic version-A chance for vaginal delivery at breech presentation. Medicina (Kaunas). 2022; 58(11): 1619. https://dx.doi.org/10.3390/medicina58111619
  4. Lei L., Fang Z., Xu C., Wang Z., Li H., Ma L. Effect of anesthesia on the success rate of external cephalic version: GRADE- assessed systematic review and meta-analysis of randomized controlled trials. Syst. Rev. 2024; 13(1): 202. https://dx.doi.org/10.1186/s13643-024-02616-y
  5. Borgmeier F., Horst de Cuestas S., Pruss M., Fath N., Hagenbeck C. Neonatal outcome following external cephalic version (ECV)-comparison between vaginal birth after successful ECV and elective caesarean section after unsuccessful ECV. J. Clin. Med. 2024; 13(13): 3837. https://dx.doi.org/10.3390/jcm13133837
  6. de Wolff M.G., Ladekarl M., Sparholt L., Lykke J.A. Rebozo and external cephalic version in breech presentation (RECEIVE): a randomised controlled study. BJOG. 2022; 129(10): 1666-75. https://dx.doi.org/10.1111/1471-0528.17111
  7. Sánchez-Romero J., Gallego-Pozuelo R.M., Blanco-Carnero J.E., Herrera-Giménez J., Araico-Rodríguez F., Guijarro-Campillo A.R. et al. External cephalic version outcomes with tocolysis and sedation: a 10-year retrospective cohort study. Int. J. Gynaecol. Obstet. 2025. https://dx.doi.org/10.1002/ijgo.70711
  8. Bevilacqua E., Jani J.C., Meli F., Carlin A., Bonanni G., Rimbault M. et al. Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols. AJOG Glob. Rep. 2022; 2(4): 100086. https://dx.doi.org/10.1016/j.xagr.2022.100086
  9. Fernández-Carrasco F.J., Cristóbal-Cañadas D., Gómez-Salgado J., Vázquez-Lara J.M., Rodríguez-Díaz L., Parrón-Carreño T. Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: a systematic review and meta-analysis. J. Glob. Health. 2022; 12: 04055. https://dx.doi.org/10.7189/jogh.12.04055
  10. Дударева Ю.А., Антонова С.А., Живетьева Н.В. Наружный поворот плода на головку в современном акушерстве: оценка эффективности и безопасности. Российский вестник акушера-гинеколога. 2023; 23(6‑2): 162‑6. [Dudareva Yu.A., Antonova S.A., Zhivet’eva N.V. External version in modern obstetrics: assessment of efficacy and safety. Russian Bulletin of Obstetrician-Gynecologist. 2023; 23(6-2): 162-6 (in Russian)]. https://dx.doi.org/10.17116/rosakush202323062162
  11. Шрамко С.В., Леонова Е.С., Алексеева М.В. Наружный акушерский поворот плода. Мать и дитя в Кузбассе. 2024; 1(96): 97-100. [Shramko S.V., Leonova E.S., Alekseeva M.V. External obstetric rotation of the fetus. Mother and Baby in Kuzbass. 2024; 1(96): 97-100 (in Russian)]. https://dx.doi.org/10.24412/2686-7338-2024-1-97-100
  12. Kwiatek M., Geca T., Stupak A., Kwasniewski W., Mlak R., Kwasniewska A. External cephalic version - single-center experience. Ginekol. Pol. 2024; 95(10): 779-84. https://dx.doi.org/10.5603/gpl.99736
  13. Семенова Э.Р. Наружный поворот плода на головку при тазовом и поперечном положении плода. Акушерство и гинекология. 2019; 11: 192-6. [Semenova E.R. External cephalic version in cases of pelvic and transverse lie. Obstetrics and Gynecology. 2019; (11): 192-6 (in Russian)]. https://dx.doi.org/10.18565/aig.2019.11.192-196
  14. Hakem E., Lindow S.W., O'Connell M.P., von Bünau G. External cephalic version - a 10-year review of practice. Eur. J. Obstet. Gynecol. Reprod. Biol. 2021; 258: 414-7. https://dx.doi.org/10.1016/j.ejogrb.2021.01.044
  15. Shanahan M.M., Martingano D.J., Gray C.J. External cephalic version. 2023 Dec 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–.
  16. Andre N., Hamad A.A., Mastrolia S.A., Baumfeld Y., Sheiner E., Bernstein E.H. et al. Enhancing external cephalic version success: insights from an Israeli tertiary center. J. Perinat. Med. 2025; 53(4): 517-22. https://dx.doi.org/10.1515/jpm-2024-0546
  17. Levin G., Ezra Y., Weill Y., Kabiri D., Pollack R.N., Rottenstreich A. Nifedipine versus ritodrine during external cephalic version procedure: a case control study. J. Matern. Fetal. Neonatal. Med. 2021; 34(18): 3008-13. https://dx.doi.org/10.1080/14767058.2019.1677589
  18. Riemma G., Schiattarella A., La Verde M., Cianci S., Savoia F., De Franciscis P. et al. Usefulness of atosiban for tocolysis during external cephalic version: systematic review and meta-analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2021; 258: 86-92. https://dx.doi.org/10.1016/j.ejogrb.2020.12.053
  19. Athiel Y., Girault A., Le Ray C., Goffinet F. Association between hospitals' cesarean delivery rates for breech presentation and their success rates for external cephalic version. Eur. J. Obstet. Gynecol. Reprod. Biol. 2022; 270: 156-63. https://dx.doi.org/10.1016/j.ejogrb.2022.01.007
  20. Yi J., Tang Z., Chen X., Zhang X., Zhang B., Liu D. et al. Predictive factors for a successful external cephalic version: an observational study of four years' experience in China. Ann. Med. 2025; 57(1): 2598905. https://dx.doi.org/10.1080/07853890.2025.2598905
  21. Cillard L., Verhaeghe C., Spiers A., Madzou S., Descamps P., Legendre G. et al. External cephalic version: predictors for success. J. Gynecol. Obstet. Hum. Reprod. 2021; 50(9): 102165. https://dx.doi.org/10.1016/j.jogoh.2021.102165
  22. Londero A.P., Xholli A., Massarotti C., Fruscalzo A., Cagnacci A. Factors influencing the effect of external cephalic version: a retrospective nationwide cohort analysis. Arch. Gynecol. Obstet. 2023; 308(4): 1127-37. https://dx.doi.org/10.1007/s00404-022-06763-2
  23. Unno S., Ogawa K., Nukariya A., Umehara N., Sago H. Predictive factors for successful external cephalic version with regional anesthesia. J. Obstet. Gynaecol. Res. 2023; 49(5): 1335-40. https://dx.doi.org/10.1111/jog.15615
  24. External cephalic version: ACOG Practice Bulletin, number 221. Obstet. Gynecol. 2020; 135(5): e203-12. https://dx.doi.org/10.1097/AOG.0000000000003837
  25. Lomas S., Minton Z., Daniels J.P. Systematic review of the effectiveness of remifentanil in term breech pregnancies undergoing external cephalic version. Int. J. Obstet. Anesth. 2023; 54: 103649. https://dx.doi.org/10.1016/j.ijoa.2023.103649
  26. Kabiri D., Haj Yahya R., Yahalomi S., Ezra Y. Impact of full vs empty urinary bladder on external cephalic version success: a randomized controlled trial. Am. J. Obstet. Gynecol. MFM. 2023; 5(7): 100991. https://dx.doi.org/10.1016/j.ajogmf.2023.100991
  27. Yerrabelli R.S., Lee C., Palsgaard P.K., Lauinger A.R., Abdelsalam O., Jennings V. Prediction models for successful external cephalic version: an updated systematic review. Am. J. Perinatol. 2024; 41(S01): e3210-40. https://dx.doi.org/10.1055/a-2211-4806
  28. Dong T., Chen X., Zhao B., Jiang Y., Chen Y., Lv M. et al. Development of prediction models for successful external cephalic version and delivery outcome. Arch. Gynecol. Obstet. 2022; 305(1): 63-75. https://dx.doi.org/10.1007/s00404-021-06115-6
  29. Newman R.B., Peacock B.S., VanDorsten J.P., Hunt H.H. Predicting success of external cephalic version. Am. J. Obstet. Gynecol. 1993; 169(2 Pt 1): 245-9; discussion 249-50. https://dx.doi.org/10.1016/0002-9378(93)90071-p
  30. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Резус-изоиммунизация. Гемолитическая болезнь плода. М.; 2024. 21 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Rh-isoimmunization. Hemolytic disease of the fetus. Moscow; 2024. 21 p. (in Russian)].
  31. Reicher L., Lavie A., Fouks Y., Isakov O., Attali E., Yogev Y. et al. Efficacy of a second external cephalic version (ECV) after a successful first external cephalic version with subsequent spontaneous reinversion to breech presentation: a retrospective cohort study. Arch. Gynecol. Obstet. 2021; 303(4): 911-6. https://dx.doi.org/10.1007/s00404-020-05819-5
  32. Sánchez-Romero J., Gallego-Pozuelo R.M., Ortuño-Hernández C., Martínez-Zarco A., Barroso-Linares R., Araico-Rodríguez F. et al. Ultrasound assessment of breech engagement: breech progression angle and prediction of external cephalic version success. J. Clin. Med. 2025; 14(20): 7179. https://dx.doi.org/10.3390/jcm14207179
  33. Youssef A., Brunelli E., Fiorentini M., Lenzi J., Pilu G., El-Balat A. Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal. Ultrasound Obstet. Gynecol. 2021; 58(4): 609-15. https://dx.doi.org/10.1002/uog.23649
  34. Dahl C.M., Zhang Y., Ong J.X., Yeh C., Son M., Miller E.S., Roy A., Grobman W.A. Patient characteristics associated with complications of external cephalic version. Am. J. Obstet. Gynecol. MFM. 2021; 3(5): 100411. https://dx.doi.org/10.1016/j.ajogmf.2021.100411
  35. Matsui H., Ogawa K., Okamoto A., Sago H. Risk factors and outcomes of abnormal bleeding after external cephalic version. J. Perinat. Med. 2021; 49(6): 733-9. https://dx.doi.org/10.1515/jpm-2020-0453
  36. Engel O., Arnon S., Shechter Maor G., Schreiber H., Piura E., Markovitch O. The effect of external cephalic version on fetal circulation: a prospective cohort study. Children (Basel). 2023; 10(2): 354. https://dx.doi.org/10.3390/children10020354
  37. Fitiri M., Papavasileiou D., Mesaric V., Syngelaki A., Akolekar R., Nicolaides K.H. Routine 36-week scan: diagnosis and outcome of abnormal fetal presentation. Ultrasound Obstet. Gynecol. 2025; 65(2): 154-62. https://dx.doi.org/10.1002/uog.29139
  38. Tamura N., Takeda J., Suga Y., Kumagai A., Matsuzawa N., Yamamoto Y. et al. Reducing medical costs by adopting external cephalic version in a single perinatal center in Japan. J. Obstet. Gynaecol. Res. 2025; 51(8): e70031. doi: 10.1111/jog.70031

Received 16.03.2026

Accepted 09.04.2026

About the Authors

Dmitry A. Babich, PhD, Obstetrician Gynecologist at the1st Maternity Department, Associate Professor at the Department of Continuing Professional Education and Simulation Technologies, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(903)295-05-05, d_babich@oparina4.ru, https://orcid.org/0000-0002-3264-2038
Oleg R. Baev, Dr. Med. Sci., Professor, Head of the 1st Maternity Department, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparina str., 4; Professor at the Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, o_baev@oparina4.ru, https://orcid.org/0000-0001-8572-1971
Ekaterina D. Ivanova, Postgraduate Student, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2,
+7(977)909-08-29, katrina.dip.13@gmail.com, https://orcid.org/0009-0006-0016-4701
Corresponding authors: Dmitry A. Babich, d_babich@oparina4.ru; Oleg R. Baev, o_baev@oparina4.ru

Similar Articles

№7 / 2025
Zharkin N.A., Miroshnikov A.E., Kostenko T.I., Shatilova A.D., Dvoryansky S.A., Dmitrieva S.L., Tskhay V.B., Raspopin Yu.S., Falkenberg M.E., Marina M.O., Artymuk N.V., Marochko T.Yu., Guseva O.I., Soboleva A.M., Panova T.V., Padrul M.M., Trushkov A.G.
Analysis of the causes of relaparotomy after cesarean section (multicenter study)
№2 / 2024
Krot I.F., Rukhlyada N.N., Romanova L.A., Reznik V.A., Sergienko O.I., Chikhladze B.U., Vartanyan R.A.
Myomectomy during cesarean section
№5 / 2025
Chuchalina L.Yu., Shuvalova M.P., Grebennik T.K., Aleshina E.A., Kan N.E.
Experience of implementation of new medical technologies in obstetrics and gynecology within the framework of organizational and methodological guidance of the national medical research centre
№4 / 2024
Babich T.Yu., Sulima A.N., Baskakov P.N., Suleymanova S.R.
Delivery in a pregnant woman with a bicornuate uterus and a scar after cesarean section
№4 / 2024
Loginova E.A., Valiev R.K., Ivanova L.B., Davydova I.Yu., Dymova A.V.
Uterine niches following cesarean section: the problem of diagnosis and treatment
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.