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Are term breech babies who undergo successful external cephalic version still at increased risk of developmental dysplasia of the hip?
  1. Joanne Stock1,2,
  2. Sanjeev A Deshpande2
  1. 1 Medical School, Keele University, Keele, UK
  2. 2 Neonatal Unit, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
  1. Correspondence to Dr Joanne Stock, Princess Royal Hospital NHS Trust, Shrewsbury, SY3 8XQ, UK; joanne.stock{at}

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A 36-hour-old neonate is undergoing their newborn and infant physical examination (NIPE). Antenatal scans showed that the baby was in the breech position at 36 weeks’ gestation. However, the mother underwent a successful external cephalic version (ECV) procedure at 37 weeks and had an uneventful normal vaginal delivery (with a cephalic presentation). There are no other risk factors for developmental dysplasia of the hips (DDH), and the baby’s hip examination using the Ortolani and Barlow manoeuvres is normal. You wonder whether the baby still requires referral for routine hip ultrasound.

Structured clinical question

Is a neonate who has previously been in breech position at/near term (patient) but has undergone successful ECV (risk factor) still at increased risk of DDH (outcome)?


Searches were conducted of Medline (via PubMed) and Embase using the following search strategy:

(Developmental dysplasia of the hip OR DDH OR hip dysplasia OR congenital hip dysplasia OR congenital hip dislocation OR congenital dysplasia of the hip OR congenital dislocation of the hip) AND (External cephalic version OR ECV). Searches returned eight and six results, respectively. Study abstracts and full texts were reviewed with three studies deemed relevant (table 1).

View this table:
Table 1

Summary of studies included in review including levels of evidence8


DDH is characterised by hip joint instability with potential long-term effects on mobility if untreated. Affected individuals have abnormal development of the acetabulum and femoral head and consequently can display dislocatable or dislocated hip joints …

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  • Contributors JS developed the initial manuscript which was reviewed and approved by SAD. SAD supported with initial concept and approach.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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