nursing -obg note-version

1. VERSION
BY
JASMI MANU
head of the department
Obs/gyn Nursing
Rama university
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2. Definition
Version is an operation in which
the presentation of the fetus is
artificially altered, either substituting
one pole of the longitudinal fetus to
the other, or converting an oblique or
transverse lie into a longitudinal lie.
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3. History
Hippocrates
Aeitus and Celsius
Galen
Ambroise Pare (1510 – 1590)
Wigand (1807)
Braxton Hicks
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4. Types of Version
External Cephalic version
Internal Podalic version
Bipolar version
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5. External version
Definition:
External cephalic version is done
to convert a transverse lie or oblique lie
or a breech presentation into a cephalic
presentation by abdominal
manipulation.
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6. Indications
Breech Presentation
Transverse or oblique lie
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7. Contraindications
Multiple pregnancy
Ante partum hemorrhage
Severe pregnancy induced
hypertension
Major degree of pelvic
contraction
Planned caesarean section
Scar on the uterus of previous
surgery
Rh – isoimmunization
Preterm labour in
current pregnancy
Patient is still preterm
Elderly primigravida
Threatened rupture of
uterus
Conditions that
contraindicate tocolytic
agents
Gross fetal abnormality
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8. Prerequisites for ECV
Presenting part must not be engaged
Abdominal wall must be sufficiently thin to allow
palpation
The abdominal and uterine wall must not be highly
irritable
The uterus must contain sufficient amount of liquor
amnii to allow easy movement of the fetus
Gestational age more than 32 weeks, referably 34 to
36 weeks
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11. Postoperative Management
Bed rest in left lateral position
Tocolytic therapy for 2 hours
Monitor fetal heart rate every 15 minutes for 2
hours
Monitor maternal vital parameters every 15
minutes for 2 hours
Watch for bleeding per vaginum, leaking and
abdominal pain
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12. Causes for Failure
1. Too big baby
2. Too little amount of
liquor
3. Frank breech
4. Obesity
5. Uterine leiomyomas
6. Uterine anomalies
7. Short umbilical cord
Complications
• Preterm labour
• Abruptio placenta
• Looping of cord
• Umbilical cord
presentation
• Intra uterine death
• Premature rupture of
membranes
• True knots in the cord
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13. Internal Podalic Version
Internal podalic version is the
conversion of the fetal presentation
from a transverse or cephalic
presentation by both intrauterine
manipulations as well as abdominal
maneuvers
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14. Indications
• Second twin in transverse lie
• Failure of external cephalic version
• Transverse lie in multipara with full cervical
dilatation
• Placenta praevia with excessive vaginal
bleeding
• Fetus (dead or too preterm) to survive after a
caesarean section
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15. Contraindications
A scar on the uterus from a previous operation
Threatened rupture of the uterus
Multiple pregnancy
Congenital malformation of the uterus
Major degree of pelvic contraction
Placenta praevia degree III and IV
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16. Prerequisites
→Cervix must be at least ¾ dilated
→Membranes intact or just ruptured
→Uterus contracting intermittently with
relaxation in between
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17. Technique
1. Instrument trolley
Iodine for part preparation
Simple urinary catheter
Sterile drapes:4
Sponge holding forceps:4
Version gloves:2 pairs
Episiotomy scissors
Instrument for suturing an episiotomy
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18. 2. General anesthesia is given along with an uterine
relaxant
3. Lithotomy position
4. Episiotomy is made
5. Glove application
6. Introduce the well lubricated right hand into the uterine
cavity.
7. Rupture membranes if they are intact
8. Pass the hand on the dorsal aspect of the fetus to its
ventral aspect along its breech. The superior leg is
grasped and delivered across the ventral aspect of the
foetus.
9. The leg is being brought down and the fetal head is
manipulated abdominally and shifted to the uterine
fundus. 18

19. 10. An immediate breech extraction may be
planned.
11. Soon after the delivery, the uterine cavity is
explored for injury
12. Halothane is discontinued.
13. Oxytocin infusion is started.
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21. Complications
Uterine rupture
Postpartum hemorrhage
Puerperal sepsis
Foetal injury or death
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22. Role of a nurse
External cephalic version
Check fetal heart rate before the procedure.
Pre medications
Fetal heart rate assessment soon after the procedure
every 15 minutes for 2 hours.
Observe for vaginal bleeding contractions and leaking.
Internal podalic version
Arrange for blood
Preparation for general anesthesia
Arrange operation theatre
Resuscitation of newborn.
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23. • https://www.youtube.com/watch?v=aWTmxPV15
DI
• https://www.youtube.com/watch?v=q0uoScLhw
HI
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