Just do the ECV, Just do it - This, I call it a Miracle: Understanding External Cephalic Version Practices - A Miracle in Obstetrics

Q: What is the purpose of external cephalic version (ECV) in this study?

ECV aims to manually rotate a malpresented fetus to a cephalic position to reduce cesarean delivery rates and support vaginal delivery.

Q: How was the study conducted at Korle Bu Teaching Hospital?

Researchers carried out a prospective, multi-modal cohort study of eligible obstetrics patients and observed antenatal counseling. They then recruited patients and clinicians for semi-structured postpartum interviews.

Q: What barriers affected whether clinicians offered ECV and whether patients pursued it?

Clinician barriers included prior cesarean history and training/resource limitations. Patients refrained when they lacked understanding of the procedure and its complications.

Sep 29, 2026

Uploaded by Anna Hans

External cephalic version (ECV) is a proven, low-risk, low-resource, and cost-effective procedure used by skilled clinicians to reduce cesarean delivery rates for fetuses with malpresentation. Evidence on ECV practices in low- and middle-income countries remains limited. This prospective, multi-modal cohort study at Korle Bu Teaching Hospital in Ghana evaluates malpresentation counseling, decision-making, and ECV practice among eligible obstetrics patients and clinicians.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

Study focus

ECV rationale and evidence gap

Methods

Participants and setting

Data collection and interviews

Statistical and qualitative analysis

Findings

ECV offer and uptake

Clinician and patient barriers

Perceptions of ECV

Implications

Michigan Medicine University of Michigan–Ann Arbor Korle Bu Teaching Hospital University of Michigan–Ann Arbor University of Michigan–Ann Arbor Michigan Medicine University of Ghana University of Ghana Michigan Medicine Avoidable cesarean deliveries, health equity, ECV, obstetrics procedures, obstetrics complications, malpresentation December 30th, 2025 [https://doi.org/10.21203/rs.3.rs-8347543/v1](https://doi.org/10.21203/rs.3.rs-8347543/v1) 􀁱 􀅏 This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License No competing interests reported. External cephalic version (ECV) is a proven, low-risk, low-resource, and cost-effective procedure, when performed by a skilled healthcare professional, to reduce cesarean delivery (CD) rates for malpresented fetuses. Information regarding ECV practices in low-and middle-income countries is limited. We sought to understand and evaluate malpresentation counseling, decision-making, and ECV practices from the perspective of clinicians and patients at the largest referral teaching hospital in Ghana. We conducted a prospective, multi-modal cohort study of obstetrics patients who were eligible for ECVat Korle Bu Teaching Hospital in Accra, Ghana between July 1 and December 31, 2024. We enrolled pregnant patients who were ≥ 36 weeks gestation diagnosed with malpresentation. After enrollment, the research team directly observed the patients’ antenatal care visits to collect data on the counseling related to their malpresentation diagnosis, ECV if applicable, and obtained delivery information postpartum via their medical record. Postpartum, patients and their clinicians were recruited to complete semi-structured interviews to understand their perspectives and decision-making regarding ECV. We performed descriptive and inferential statistics including cross-tabulation with Chi-square analysis or Fisher’s exact test for categorical variables and independent samples t-test or analysis of variance for continuous variables. Statistical signi«cance was de«ned at p < 0.05. Interviews were audio-recorded, translated, transcribed, coded, and thematically analyzed. Among 46 enrolled patients at 36 weeks’ gestation who were eligible for ECV, only 21 (45 .7%) were offered ECV, and 17 (37 .0%) underwent ECV. History of one previous CD and training and resource limitations were barriers to clinicians offering ECV. Patients refrained from pursuing ECV if they lacked understanding of the procedure and its complications. Overall, patients and clinicians positively perceived ECV and valued its ability to decrease CD rates. This study demonstrates important opportunities to improve counseling, utilize evidence-based indications to offer ECV to patients with pregnancies complicated by malpresentation, and ensure clinicians—and potentially midwives—are trained to perform ECV. Addressing these opportunities successfully could improve the number of healthcare professionals who practice safe and effective ECV in sub-Saharan Africa and potentially decrease avoidable rates of CD and their associated morbidity and mortality. Evidence shows that cesarean delivery (CD) rates above 19% do not decrease maternal morbidity and mortality.1 When not medically necessary, CD pose a greater risk to maternal and neonatal health compared to vaginal delivery, especially in low-and middle-income countries (LMICs), where perioperative resources may be limited.1–3 In 2020, over 95% of maternal deaths occurred in LMICs, with the majority being preventable. This highlights the urgent need to reassess the current use of CDs in LMICs in reducing maternal morbidity and mortality.4 In 2022, the national CD rate in Ghana was 21%,5 while 2016 data indicate the CD rate at Korle Bu Teaching Hospital (KBTH), a tertiary referral hospital where the current research was conducted, was 46.9% .6 The third most common indication for primary CD is malpresentation, when the fe

FAQs

What is the purpose of external cephalic version (ECV) in this study?

ECV aims to manually rotate a malpresented fetus to a cephalic position to reduce cesarean delivery rates and support vaginal delivery.

How was the study conducted at Korle Bu Teaching Hospital?

Researchers carried out a prospective, multi-modal cohort study of eligible obstetrics patients and observed antenatal counseling. They then recruited patients and clinicians for semi-structured postpartum interviews.

What barriers affected whether clinicians offered ECV and whether patients pursued it?

Clinician barriers included prior cesarean history and training/resource limitations. Patients refrained when they lacked understanding of the procedure and its complications.

Sep 29, 2026

Uploaded by Anna Hans