Practical technique and clinical management guide for external cephalic version

The external cephalic version (ECV) is a manual procedure that rotates the fetus from breech to cephalic presentation through external abdominal manipulation. Major international guidelines recommend offering ECV at term to eligible women to reduce cesarean delivery rates. However, detailed technical guidance and standardized perioperative management remain limited. This review aims to provide a practical and clinically applicable guide based on an established institutional protocol, covering key preparatory measures, including patient selection and informed consent, a reproducible step-by-step technique, and post-procedure management. ECV is generally indicated for singleton breech pregnancies at or beyond 37 weeks of gestation, when vaginal birth is not contraindicated. Informed consent is required as an elective procedure, supported by balanced counseling on risks, benefits, and shared decision-making. Preprocedural management includes ultrasound assessment, fetal monitoring, and the use of ritodrine hydrochloride and neuraxial analgesia to enhance comfort and facilitate uterine relaxation. This technique emphasizes complete disengagement of the fetal buttocks, direction-specific wide-arc rotation of the fetal head while maintaining continuous upward lifting of the fetal buttocks, and secure engagement of the head beneath the pubic symphysis to prevent reversion. This step is followed by ultrasound confirmation that no umbilical cord or fetal extremity is present before the head. Safety was reinforced by performing the procedure in an operating room with immediate access for cesarean delivery and appropriate postprocedure monitoring. By offering a concise, reproducible approach and a supplementary procedural video, this review supports safer and more effective implementation of ECV and may help reduce unnecessary cesarean births.