ECV by Abhishek Jaguessar

8/4/2019 ECV by Abhishek Jaguessar

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External Cephalic

VersionBY

ABHISHEKJAGUESSAR


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4/13/2012 2External Cephalic Version

Spontaneous version

After 32/40 is as high as 57% andafter 36/40 may still be as high as 25%.

Is more in multiparous. Less likely in primipara and extended

breech.


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Promotion of spontaneousversion

Any factor which promotesdisengagement.

Postural changes (Knee-chest position).


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ECV

Before 1970:

Performed without tocolysis.

Prior to 36/40. With or without sedation.


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After 1978,after 36/40:

Preferably with tocolysis.

Lower incidence of complications Avoidance of PTL and delivery.


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Risksof ECV

Severe bradycardia requires immediatedelivery by CS.

1% IUFD. Spontaneous reversion.


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Results of meta-analysis

Reduction in breech birth from 78% to44%.

Reduction in CS rate from 29% to 15%.


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Benefits to fetus

Decreases the risks of foetal trauma.

Decreases the incidence of cordprolapse.

Decreases the rate of unattendedbreech delivery.


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Risks to the foetus

Review of 979 cases:

8% bradycardia due to short termhypoxia.

(49) 5% Feto-maternal haemorrhagewith tocolysis and 285 (29%) without.


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Benefits to the mother

Reduction in significant maternalcomplication

Cs may compromise future reproduction.

Emotional sequelae.

Higher maternal death.


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Indications and contra-indications

37/40 and above:

Gestational age-37,38,40: 40 moresuccessful than 39,38 more than 37.

EFW: the bigger the foetus the lesssuccessful ECV.

Tense abdomen/uterus. Difficulty in palpating the foetal head.

Increasing parity.


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AF less than 2 cm in any pocket.

Back of the foetus anteriorly.

Maternal obesity.


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Indications

Any breech after 36/40.

Un-engaged breech.


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Contra-indications

Absolute:

Multiple pregnancy.

APH, P.Praevia.

Ruptured membranes.

Significant foetal abnormalities.

Need for CS for other indications.

Tocolysis is C/I in congenital or acquiredheart disease, DM or thyroid disease.


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Relative:

Previous CS.

IUGR. Severe protienuric PIH.

RH iso-immunization.

(Evidence of macrosomia). (Grand-multi-para).


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(Anterior placenta).

(Precious baby).

(Previous APH). (Suspected foetal compromise).

(Uterine anomaly).


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Pre-requisites

USS to confirm normal baby and normalAFV.

Reactive CTG.

Informed concent: PTL, ROM,cord andplacental accident.

Facilities for immediate CS. Kleihauer test.


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IV line.

Clinical pelvimetry.


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Procedure

Position: -slight lateral tilt

- trendelenburg.

Tocolysis. One operator.

Continuous pressure should be limited to

5 minutes. Dis-engagement of the breech.


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Forward or backward methods withflexion or slight extension.

CTG.


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Maternal and foetal factors inbreech

228 singleton breech;

96 remained as breech at delivery.

132 turned sopntaneously. Nulliparas comprised 60%.

Gestational age was 10 days less in the

beech group. Weight, length and HC at birth were

lower in the breech.


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AFV was lower in the breech, 8oligohydramnios to 1.

Only 15% of the breech had identifiablecause.


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Conclusion

Current evidence indicates that ECVperformed at term with tocolysis issafe procedure for carefully selected

cases. The short term complications are

negligible and the long term ones are

hard to determine.

ECV by Abhishek Jaguessar

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