Place of external cephalic version
The place of external cephalic version: Upto the 34th week of pregnancy breech presentations are common. Many breech presentations by that period correct themselves spontaneously into vertex presentations. After the 34th week, the incidence of such spontaneous corrections drop down significantly and after the 36th week it is rather rare. Hence it is suggested that if a breech presentation is found to persist after the 34th week, it is better to try and convert it into a vertex. At this period the correction is easier and the chances of recurrence after correction are diminished. Later in pregnancy, the difficulties of conversion are greater because of the increasing size of the child and the diminishing liquor amnii.
Is it necessary to correct all breech presentations into vertex? This can be answered only by comparing the fetal mortality of successful external version and vertex delivery with that of breech delivery as such. In a carefully executed external version, the fetal mortality due to this procedure is less than one per cent and even in the best of hands, especially in a primigravida, the fetal mortality for breech deliveries is higher than with a vertex after external version. Hence there is definitely a case for external version in all primigravida. The case is further strengthened when the pelvis is borderline, for a vertex presentation permits a trial labour, while with a breech no such trial is possible.
While there are many who hold the view that every case of breech presentation must be converted into a vertex, we believe that in a multigravida, with a good obstetric record, such a procedure is not imperative. The hazards of a breech delivery in such a patient are much less. If the attending obstetrician does not have enough experience or confidence in dealing with breech deliveries, he should make every attempt to convert a breech delivery into a vertex.
Tags: BPD, breech
Posted in Health |
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