Clinical examination for non-cephalic presentation: External cephalic version should be a maternity service quality indicator

doi:10.1136/bmj.333.7570.705-c

BMJ 2006;333:705-706 (30 September), doi:10.1136/bmj.333.7570.705-c

Letter

Clinical examination for non-cephalic presentation

External cephalic version should be a maternity service quality indicator

The first 150 words of the full text of this article appear below.

EDITOR—The recent study by Nassar et al highlights thelong known clinical failure to diagnose all breech presentationsat term, especially in obese women.¹ However, there is littlepoint in improving clinical detection unless it makes a differenceto mothers or babies. The point of detecting a breech is tooffer external cephalic version and to discuss mode of deliveryif persistent. If external cephalic version is successful itavoids the hazards of vaginal breech delivery and caesareansection.²³

The National Sentinel Caesarean Section Audit showed that only33% of women in the United Kingdom who were having caesareansections for breech presentations had been offered an externalcephalic version, and less than half of these had had the procedure.⁴A recent systematic review confirmed the high success rates(> 60% in some studies) and the extremely low risks of externalcephalic version.⁵ Set against the well documented . . . [Full text of this article]

Stephanie Kuku, senior house officer

Womens' Health Directorate, St Thomas' Hospital, London SE1 7EH Stephanie.Kuku@gstt.nhs.uk

Susan Bewley, consultant obstetrician

Womens' Health Directorate, St Thomas' Hospital, London SE1 7EH

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