External cephalic version is considered at term for breech presentation. Which of the following is a contraindication?

• A. Placenta previa.
• B. Prior low transverse cesarean section.
• C. Nonreassuring fetal status.
• D. Breech with no maternal risk factors.

Answer: (A)

External cephalic version aims to turn a breech fetus to a head-down position at term to reduce cesarean delivery. It’s done in a monitored setting with ultrasound to check placental location and fetal status and to manage any complications.

Placenta previa is an absolute contraindication because the placenta covers the cervical canal. Repositioning the fetus could disrupt the placental attachment and trigger severe vaginal bleeding or placental abruption, risking both mother and baby. In contrast, a prior low transverse cesarean section is not a barrier to ECV; many centers perform ECV in these patients with appropriate monitoring. Nonreassuring fetal status is a relative contraindication—fetal distress raises concerns about whether manipulating the fetus could worsen the condition, so delivery may be preferred. A breech with no maternal risk factors represents a scenario where ECV is appropriate and often pursued.