External Cephalic Version | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

290

Pages:

3
Author:

Mariam A. A.

External Cephalic Version Key Info The procedure only lasts for a few minutes 40 to 60% success rate 40% in nulliparous women 60% in multiparous women Offered at term birth 37 weeks In nulliparous women -> offer at 36 weeks Since have lower chance of spontaneous version after 36 weeks. No more than 4 attempts over a maximum of 10 minutes If Rh negative should be offered anti-D within 72 hours -> regardless of how successful, the ECV is There is no evidence that postural management alone promotes spontaneous version to cephalic version. If not successful C section is recommended Offered to all women unless there is a contradiction Procedure Ultrasound confirmation of breech Check fluid levels Check placenta Check fetal wellbeing Consent and prep Give mum uterine relaxants e.g. terbutaline Improves success rate Mum is to lie on her back Doctor applies pressure on mum’s abdomen First lifts the baby’s bum Then rotates forward or backward depending on their position Continuous monitoring of the baby’s heart rate via CTG Post procedure Confirm the baby’s position and reassess wellbeing Observe mum for 30 minutes after the procedure Complications/adverse outcomes 1 in 200 women will need emergency C section due to: Placental abruption Cord prolapses Acute fetal compromise Bradycardia Fetomaternal haemorrhage No reassuring CTG pattern In 4.3% minor complications -> transient and detected in CTG (less than 3 minutes) Rupture of membranes Small antepartum haemorrhage Need for C section is less than women in normal labour Hence fasting is not required But each woman should be assessed for individual risk factors Determinants of success Parity Fluid volume Fetal position Flexed/complete breech more likely to succeed Frank presentation less likely to succeed Contraindications Absolute Relative Anything that would necessitate a c section – placenta previa SGA Antepartum haemorrhage within the last 7 days Pre-eclampsia Abnormal CTG Oligohydramnios Ruptured membranes Major fetal anomalies Rhesus isoimmunisation Uterine anomalies Multiple gestation Less likely to be successful