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External Cephalic Version

9/13/2012. 2. External Cephalic Version. Spontaneous version. After 32/40 is as high as 57% and after 36/40 may still be as high as 25%.Is more in multiparous.Less likely in primipara and extended breech. . 9/13/2012. 3. External Cephalic Version. Promotion of spontaneous version. Any factor which

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External Cephalic Version

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    1. External Cephalic Version

    2. 9/13/2012 2 External Cephalic Version Spontaneous version After 32/40 is as high as 57% and after 36/40 may still be as high as 25%. Is more in multiparous. Less likely in primipara and extended breech.

    3. 9/13/2012 3 External Cephalic Version Promotion of spontaneous version Any factor which promotes disengagement. Postural changes (Knee-chest position).

    4. 9/13/2012 4 External Cephalic Version ECV Before 1970: Performed without tocolysis. Prior to 36/40. With or without sedation.

    5. 9/13/2012 5 External Cephalic Version After 1978,after 36/40: Preferably with tocolysis. Lower incidence of complications Avoidance of PTL and delivery.

    6. 9/13/2012 6 External Cephalic Version Risks of ECV Severe bradycardia requires immediate delivery by CS. 1% IUFD. Spontaneous reversion.

    7. 9/13/2012 7 External Cephalic Version Results of meta-analysis Reduction in breech birth from 78% to 44%. Reduction in CS rate from 29% to 15%.

    8. 9/13/2012 8 External Cephalic Version Benefits to fetus Decreases the risks of foetal trauma. Decreases the incidence of cord prolapse. Decreases the rate of unattended breech delivery.

    9. 9/13/2012 9 External Cephalic Version Risks to the foetus Review of 979 cases: 8% bradycardia due to short term hypoxia. (49) 5% Feto-maternal haemorrhage with tocolysis and 285 (29%) without.

    10. 9/13/2012 10 External Cephalic Version Benefits to the mother Reduction in significant maternal complication Cs may compromise future reproduction. Emotional sequelae. Higher maternal death.

    11. 9/13/2012 11 External Cephalic Version Indications and contra-indications 37/40 and above: Gestational age-37,38,40: 40 more successful than 39,38 more than 37. EFW: the bigger the foetus the less successful ECV. Tense abdomen/uterus. Difficulty in palpating the foetal head. Increasing parity.

    12. 9/13/2012 12 External Cephalic Version AF less than 2 cm in any pocket. Back of the foetus anteriorly. Maternal obesity.

    13. 9/13/2012 13 External Cephalic Version Indications Any breech after 36/40. Un-engaged breech.

    14. 9/13/2012 14 External Cephalic Version 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 acquired heart disease, DM or thyroid disease.

    15. 9/13/2012 15 External Cephalic Version Relative: Previous CS. IUGR. Severe protienuric PIH. RH iso-immunization. (Evidence of macrosomia). (Grand-multi-para).

    16. 9/13/2012 16 External Cephalic Version (Anterior placenta). (Precious baby). (Previous APH). (Suspected foetal compromise). (Uterine anomaly).

    17. 9/13/2012 17 External Cephalic Version Pre-requisites USS to confirm normal baby and normal AFV. Reactive CTG. Informed concent: PTL, ROM,cord and placental accident. Facilities for immediate CS. Kleihauer test.

    18. 9/13/2012 18 External Cephalic Version IV line. Clinical pelvimetry.

    19. 9/13/2012 19 External Cephalic Version Procedure Position: -slight lateral tilt - trendelenburg. Tocolysis. One operator. Continuous pressure should be limited to 5 minutes. Dis-engagement of the breech.

    20. 9/13/2012 20 External Cephalic Version Forward or backward methods with flexion or slight extension. CTG.

    21. 9/13/2012 21 External Cephalic Version Maternal and foetal factors in breech 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.

    22. 9/13/2012 22 External Cephalic Version AFV was lower in the breech, 8 oligohydramnios to 1. Only 15% of the breech had identifiable cause.

    23. 9/13/2012 23 External Cephalic Version Conclusion Current evidence indicates that ECV performed at term with tocolysis is safe procedure for carefully selected cases. The short term complications are negligible and the long term ones are hard to determine.

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