Letters

Managing term breech deliveries

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7328.49 (Published 05 January 2002) Cite this as: BMJ 2002;324:49

External cephalic version should be routine clinical practice in UK

  1. Rajesh Varma, specialist registrar obstetrics and gynaecology (drrajesh@varma16.freeserve.co.uk),
  2. David Horwell, consultant obstetrician and gynaecologist
  1. Luton and Dunstable NHS Trust, Luton, Bedfordshire LU4 0DZ
  2. Department of Obstetrics and Gynaecology, Basildon Hospital, Basildon, Essex SS16 5NL
  3. University of Birmingham, Birmingham Women's Hospital, Birmingham B15 2TG
  4. St Thomas's Hospital, London SE1 7EH

    EDITOR—Shennan and Bewley summarise the dilemma in managing term breech presentation.1 But despite the recommendation of the Royal College of Obstetrics and Gynaecology of external cephalic version for all uncomplicated term breech pregnancies, the procedure is apparently not part of routine clinical practice in the United Kingdom.2 The reasons for this include local, national, and training issues.

    A systematic inquiry into the practice of external cephalic version in the United Kingdom is required. Questionnaire studies suggest that few British centres offer external cephalic version, although these incur selective reporting bias.3 Uptake of external cephalic version is low because of patients' refusal, contraindications to the procedure, and failure to diagnose breech presentation (R Varma et al, 29th British congress of obstetrics and gynaecology, Birmingham, July 2001). Better antenatal detection of breech presentation and broadening the inclusion criteria to include higher risk pregnancies may enhance the impact of external cephalic version. Counselling by health professionals influences the decision making process, and this should be consistent with and supplemented by local success rates of external cephalic version.

    Further training of practitioners in external cephalic version is needed, especially as there are no recognised training courses nor is it listed as an objective in the training syllabus for specialist registrars of the Royal College of Obstetrics and Gynaecology. In contrast, the syllabus for the royal college's subspecialist training in fetomaternal medicine states that the trainee should be expert in the procedure, which has a long learning curve and so would be best started early on in professional training rather than when subspecialising.

    Obstetricians' inexperience in managing vaginal breech delivery has contributed to adverse outcome and is likely to increase as a result of the current change in practice. 1 4 Nevertheless, it is impossible to deliver all term breech pregnancies by …

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