Quality statement 11: Fetal wellbeing – external cephalic version

Quality statement

Pregnant women with an uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) are offered external cephalic version.

Quality measure

Structure

a) Evidence of local arrangements to ensure that pregnant women with a suspected breech presentation at 36 weeks or later (until labour begins) are referred for confirmatory ultrasound assessment.

b) Evidence of local arrangements to ensure that pregnant women with a confirmed uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) are offered external cephalic version.

Data source: a) and b) local data collection.

Process

a) Proportion of pregnant women with a suspected breech presentation at 36 weeks or later (until labour begins) who are referred for confirmatory ultrasound assessment.

Numerator – the number of women in the denominator referred for confirmatory ultrasound assessment.

Denominator – the number of pregnant women with a suspected breech presentation at 36 weeks or later (until labour begins).

b) Proportion of pregnant women with a confirmed uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) who are offered external cephalic version.

Numerator – the number of women in the denominator offered external cephalic version.

Denominator – the number of pregnant women with a confirmed uncomplicated singleton breech presentation at 36 weeks or later (until labour begins).

Data source: a) and b) local data collection.

Outcome

a) External cephalic version rates.

b) Mode of delivery including:

  • rates of vaginal birth, emergency and elective caesarean section after successful external cephalic version.

  • rates of vaginal birth, emergency and elective caesarean section after unsuccessful external cephalic version.

  • rates of vaginal birth and emergency caesarean section after diagnosis of breech presentation in labour.

Data source: a) and b) local data collection.

b) The Maternity Services Secondary Uses Dataset, once implemented, will collect data on 'the presentation of the (first) fetus at onset of labour (including option of breech)' (global number 17204960), 'instance of a critical incident occurring (including option of undiagnosed breech)' (global number 17205700), 'the method for delivering baby' (global number 17206160).

What the quality statement means for each audience

Service providers ensure that systems are in place to offer pregnant women with an uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) external cephalic version.

Healthcare professionals offer pregnant women with an uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) external cephalic version.

Commissioners ensure they commission services that offer pregnant women with an uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) external cephalic version.

Pregnant women with a single baby in the breech position (bottom first with knees either flexed or extended) but with no other problems at 36 weeks or later in their pregnancy are offered external cephalic version (a procedure to move the baby round to the head first position), which includes first having an ultrasound scan to confirm the baby's position.

Source guidance

  • Antenatal care (2008) NICE guideline CG62, recommendations 1.10.5 and 1.11.2.1.

Definitions

As detailed in NICE guideline CG62 recommendation 1.11.2.1 women in labour or those with 1 or more of the following obstetric complications should not be offered external cephalic version:

  • a uterine scar or abnormality

  • fetal compromise

  • ruptured membranes

  • vaginal bleeding

  • medical conditions.

When obtaining informed consent for this procedure the woman should be provided with balanced information about the benefits and risks of external cephalic version (for example, the Royal College of Obstetricians and Gynaecologists patient information leaflet 'Turning a baby in the womb (external cephalic version)-information for you').

Equality and diversity considerations

There may be some women whose breech presentation is not identified and who are not offered an external cephalic version.