This document discusses unstable lie and version in pregnancy. It defines unstable lie as a condition where the fetal presentation constantly changes beyond 36 weeks of pregnancy when it should have stabilized. Causes include factors that prevent the presenting part from remaining fixed in the lower uterus. Complications include cord entanglement and increased risk of perinatal death. External cephalic version can be attempted to correct the malpresentation if there are no contraindications. Hospitalization is recommended at 37 weeks to monitor for premature rupture of membranes or cord prolapse. Elective c-section is often required, especially if complicating factors are present.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
This presentation was prepared by me, Dr. P. Chizororo, to help fellow professionals understand one of the most common malpresentations, Breech presentation. Visit my YouTube channel, Nexus Medical Media for all pre-clinical subjects
types of breech
how you can manage a woman with breech baby?
what is External cephalic version and who can do it ?
what is the risks of vaginal breech birth ?
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
3. UNSTABLE LIE
This is a condition where the
presentation of the fetus is
constantly changed even beyond
36th week of pregnancy when it
should have been stabilized.
4. CAUSES
The causes are those which prevent the presenting part to
remain fixed in the lower pole of the uterus. Such conditions
are:
Grand multipara with lack of uterine tone and pendulous
abdomen— commonest cause
Hydramnios
Contracted pelvis
Placenta previa
Pelvic tumor.
6. ANTENATAL
At each antenatal visit, the
presentation and the lie
are to be checked. If there
is no contraindication,
external version is to be
done to correct the
malpresentation.
MANAGEMENT
7. Hospitalization: The patient is to be admitted at 37th week.
Premature or early rupture of the membranes with cord prolapse
is the real danger with the lie remaining oblique.
After admission, the investigation is directed to exclude placenta
previa, contracted pelvis or congenital malformation of the fetus
with the help of sonography for localization of the placenta
8. FORMULATION OF THE LINE
OF TREATMENT:
• Elective cesarean section is
done in majority of the cases
especially in the presence of
complicating factors like pre-
eclampsia, placenta previa,
contracted pelvis, etc.
9. Stabilizing induction of labor:
• External cephalic version is done (if not contraindicated) after
37 weeks → oxytocin infusion is started to initiate effective
uterine contractions.
• This is followed by low rupture of the membranes (amniotomy).
Labor is monitored for successful vaginal delivery.
• This procedure may be done even after the spontaneous onset
of labor.
14. Spontaneous: Version process occurs spontaneously. The incidence
of spontaneous version in breech presentation is nearly 55% after 32
weeks and about 25% after 36 weeks. It is more common in
multiparous women.
External: The maneuver is done solely by external manipulation.
Internal: The conversion is done principally by one hand introducing
into the uterus and the other hand on the abdomen.
Bipolar (Braxton-Hicks): The conversion is done introducing one or
two fingers through the cervix and the other hand on the abdomen
15. When the cephalic pole is brought down to
the lower pole of the uterus, it is called
cephalic version and when the podalic pole is
brought down, it is called podalic version.
18. CONTRAINDICATIONS OF ECV
Antepartum hemorrhage (placenta previa or abruption)— risk of placental
separation
Fetal causes—hyperextension of the head, large fetus (> 3.5 kg),
congenital abnormalities (major), dead fetus, fetal compromise (IUGR)
Multiple pregnancy
Ruptured membranes—with drainage of liquor
Known congenital malformation of the uterus
Abnormal cardiotocography
Contracted pelvis
Previous cesarean delivery—risk of scar rupture
Obstetric complications: Severe pre-eclampsia, obesity, elderly
primigravida, bad obstetric history (BOH)
Rhesus isoimmunization
19. The advantages of ECV at term
By this time spontaneous version will occur in many cases
If any complications occur during ECV prompt delivery could
be done by cesarean section as the baby is at term.
Success rate of ECV in general is 60%.
Use of tocolytics (ritodrine) increases the success rate of
ECV
20. Time of version
◦ ECV has been considered from 36 weeks onwards.
◦ While version in the early weeks is easy but chance of reversion is
more.
◦ Late version may be difficult because of increasing size of the fetus
and diminishing volume of liquor amnii.
◦ However, the use of uterine relaxant (tocolysis) has made the
version at later weeks less difficult. It minimizes chance of reversion
and should fetal complications develop, it can be effectively tackled
by cesarean section.
◦ Hypertonus or irritable uterus can be overcome with the use of
tocolytic drugs.
21. Benefits of ECV
Reduces the incidence of breech presentation at term and
of breech delivery
Reduces the number of cesarean delivery
Reduces maternal morbidity due to cesarean or vaginal
breech delivery.
Reduces the fetal hazards of vaginal breech delivery
22. Preliminaries
The patient is asked to empty her bladder.
She is to lie on her back with the shoulders slightly
raised and the thighs slightly flexed.
Abdomen is fully exposed.
The presentation, position of the back and limbs are
checked and FHR is auscultated.
23. PROCEDURES
In breech presentation
The maneuver is carried out after 36 weeks in the labor-
delivery complex.
Any one of the following tocolytic drugs (Terbutaline – 0.25
mg SC or Isoxsuprine 50–100 µg IV), if required, can be
administered.
Real time ultrasound examination is done to confirm the
diagnosis and adequacy of amniotic flood volume.
A reactive NST should precede the maneuver
24. “Forward roll” movement.
Step—I
The breech is mobilized using both hands
to one iliac fossa towards which the back of
the fetus lies. The podalic pole is grasped
by the right hand in a manner like that of
Pawlik’s grip while the head is grasped by
the left hand.
25. Step—II
The pressure (firm but not forcible) is
now exerted to the head and the
breech in the opposite directions to
keep the trunk well flexed which
facilitates version. The pressure
should be intermittent to push the
head down towards the pelvis and
the breech towards the fundus until
the lie becomes transverse. The
FHR is once more to be checked.
26. Step—III: The hand is now changed one after the
other to hold the fetal poles to prevent crossing of
the hand. The intermittent pressure is exerted till
the head is brought to the lower pole of the uterus.
27.
28.
29. A reactive NST should be obtained after completing the procedure.
There may be undue bradycardia due to head compression which is
expected to settle down by 10 minutes.
If however fetal bradycardia persists, the possibility of cord
entanglement should be kept in mind and in such cases reversion
may have to be considered.
The patient is to be observed for about 30 minutes :
(1) To allow the FHR to settle down to normal
(2) To note for any vaginal bleeding or evidence of premature rupture
of the membranes.
30. Instructions
The patient is advised for follow up to check the corrected
position
To report to the physician if there is vaginal bleeding or
escape of liquor amnii or labor starts
Rh-negative nonimmunized women must be protected by
intramuscular administration of 100 µg anti-D gamma
globulin
31. External version in transverse lie
◦The version is much
easier than in breech.
The association of
placenta previa or
congenital malformation
of the uterus should be
excluded.
32. External podalic version
The external podalic version may be done in
cases when the external cephalic version fails in
transverse lie in case of the second baby of twins.
34. INDICATIONS
Internal version is hardly indicated in a singleton pregnancy in present day
obstetric practice.
Its only indication being the transverse lie in case of the second baby of
twins.
However, it may be employed in singleton pregnancy to expedite delivery in
adverse conditions where the cesarean section facilities are lacking.
Such conditions are:
(1)Transverse lie with cervix fully dilated
(2)Cord prolapse with cervix fully dilated with transverse lie or head high up
and the baby is alive.
35. Conditions to be fulfilled
The cervix must be fully dilated
Liquor amnii must be adequate for intrauterine fetal
manipulation
Fetus must be living.
38. PROCEDURES
• Assessment of the lie, presentation and FHR is made by an
experienced obstetrician by abdominal palpation, vaginal
examination and/or transabdominal ultrasound examination.
• Close (continuous) FHR monitoring is essential.
• Internal version should be done under general or epidual
anesthesia.
39. Step—I: Patient is placed in dorsal lithotomy position. Antiseptic
cleaning draping and catheterization are done.
Introduction of the hand—If the podalic pole of the fetus is on the
left side of the mother, the right hand is to be introduced and vice
versa.
The hand is to be introduced in a cone shaped manner.
It is then pushed up into the uterine cavity keeping the back of the
hand against the uterine wall until the hand reaches the podalic
pole.
40. Step—II: The hand is to pass up to the breech and then along
the thigh until a foot is grasped. The identification of the foot is
done by palpation of the heel. It is advantageous to grasp the
first foot which one encounters.
Step—III: While the leg is brought down by a steady traction,
the cephalic pole is pushed up using the external hand.
41. Step—IV: After one leg is brought down, there is no difficulty to
deliver the other leg. The delivery is usually completed with breech
extraction during uterine contractions.
Step—V: Routine exploration of the uterovaginal canal to exclude
rupture of the uterus or any other injury.
42. Complications
Maternal risk includes placental abruption, rupture of
the uterus and increased morbidity.
The fetal risk includes asphyxia, cord prolapse and
intracranial hemorrhage apart from all hazards of
breech delivery leading to a high perinatal mortality of
about 50%.
45. The bipolar version named after Braxton-Hicks is an
obsolete maneuver in present day obstetric practice.
However, it may be a life saving procedure at places,
specially in the rural areas of the developing
countries, where it is not possible to transport the
patient with placenta previa to an equipped medical
center. Its chief indication is lesser degree of placenta
previa when the fetus is dead, deformed or previable.
46. The cervix must be at least two fingers dilated to
facilitate manipulation by pushing up of the head to
one iliac fossa and to grasp one leg at the ankle.
Simultaneous manipulation by the external hand
facilitates the procedure. Bringing down of one leg
facilitates compression over the placenta and thereby
stops the bleeding
Fundal pressure to assist the process of vaginal delivery
should not be used. It results in pelvic hematoma
formation, orthopedic and neurological complications.
47. External cephalic version-related risks: a meta-analysis
K Grootscholten, M Kok, SG Oei, BW Mol, and JA van der Pos
◦ Eighty-four studies (12,955 cephalic version procedures), including 57 cohort studies,
15 randomised controlled trials and 10 case-control studies, were included in the
review. Forty-seven studies collected outcome data prospectively, 45 studies recruited
participants consecutively and 70 studies used tocolytics.
◦ The success rate for external cephalic version ranged from 16 to 100% (pooled
success rate 58%, 95% confidence interval (CI): 56 to 57; I2=94%). The pooled
complication rate was 6.1% (95% CI: 4.7 to 7.8; I2=92%). Subgroup analyses for all
complications failed to show any significant effects of study quality. Pooled odds
ratios for each individual complication type were also reported, but only analyses
related to the outcome of external cephalic version have been reported in this abstract.
48. Vaginal bleeding was significantly less likely after a successful
external cephalic version as compared with an unsuccessful attempt
(odds ratio 0.33, 95% CI: 0.14 to 0.82; four studies; I2=0%). There
were no statistically significant differences between a successful and
an unsuccessful outcome of external cephalic version, in terms of the
odds of stillbirth (eight studies), placental abruption (six studies),
cord prolapse (three studies), abnormal cardiotocography post-
intervention (foetal bradycardia, 10 studies; foetal tachycardia, two
studies), foeto-maternal transfusion (two studies) or ruptured
membranes (three studies). No significant heterogeneity was evident
for any of the pooled analyses, with the exception of foetal
bradycardia (I2=70%) and foetal tachycardia (I2=53%)