External Cephalic Version: Pregnancy
External cephalic version: The object of this procedure is to substitute a vertex for a less favourable presentation.
Indication: The common indication for external cephalic version is a breech or shoulder presentation diagnosed in the last weeks of pregnancy. Before resorting to this procedure it is necessary to make sure that 1) the abdominal waIl is sufficiently thin to permit accurate palpation, 2) the uterus is lax and contains sufficient liquor to help easy mobility of the fetus, 3) the membranes have not ruptured, and 4) the presenting part is not deeply engaged.
A majority of the malpresentations correct themselves by the 34th week of pregnancy. It is, therefore, advisable to correct, by external version, breech and shoulder presentations found persisting after 34 weeks. Correction could also be done prior to 34 weeks but more often the abnormal presentation recurs. A large baby, significant contraction of the pelvis, antepartuni hemorrhage, pre-eclampsia and a classical caesarean section scar are usually contra-indications for external version.
Technique: It is best to avoid anesthesia. The patient’s abdomen is bared and the presentation and position of the fetus are carefully ascertained, if necessary even by radiography. Each hand then seizes each of the fetal poles. The cephalic pole is then gently manipulated toward the pelvic inlet while the other is moved in the opposite direction. By a series of gentle stroking and pushing movements the head is brought over the pelvic brim. To keep it in position, an abdominal pad and binder may be applied. These patients should be re-examined a few days later when if the malpresentation has recurred, version may be tried again. External version can be attempted early in labour also, and, if successful, chances of recurrence of the malpresentation are very much reduced.
During the manipulations which should always be gentle, the fetal heart should be auscultated frequently. Any significant alterations in the fetal heart rate should be taken as a warning, and it would be wise not to proceed with the version. As far as possible the attitude of flexion in the fetus must be maintained. Premature separation of the placenta and even” rupture of the uterus
Tags: antepartuni hemorrhage, Antibiotic, breech, Delivery, ECLAMPSIA, Gonorrhoea, Infection, malpresentations, PRE-ECLAMPSIA, Pregnancy, Pubis, Uterus
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