Which of the following is a contraindication to external cephalic version (ECV)?

• A. Placenta previa
• B. Uterine anomaly
• C. Non-reassuring fetal status
• D. All of the above

Answer: (D)

External cephalic version should not be attempted when there are conditions that could harm the mother or fetus. Placenta previa means the placenta covers or is near the cervical opening; manipulating the uterus could disrupt the placenta and cause severe bleeding. A uterine anomaly, such as a septate or bicornuate uterus, can make turning the fetus unsafe or ineffective and increases the risk of uterine injury. Non-reassuring fetal status indicates the fetus is not thriving or is already distressed, so performing ECV could worsen hypoxia or distress without providing a meaningful benefit. Taken together, these scenarios make ECV contraindicated, so “all of the above” is the correct concept.