Ecv- External Cephalic Version- Define, Risk, procedure, step, benefits PPT made by sonal Patel

1. External
Cephalic
Version

2. 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.
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3. Promotion of spontaneous
version
 Any factor which promotes disengagement.
 Postural changes (Knee-chest position).
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4. ECV
 Before 1970:
 Performed without tocolysis.
 Prior to 36/40.
 With or without sedation.
After 1978,after 36/40:
 Preferably with tocolysis.
 Lower incidence of complications
 Avoidance of PTL and delivery.
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5. Risks of ECV
 Severe bradycardia requires immediate delivery by CS.
 1% IUFD.
 Spontaneous reversion.
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6. Results of meta-analysis
 Reduction in breech birth from 78% to 44%.
 Reduction in CS rate from 29% to 15%.
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7. Benefits to fetus
 Decreases the risks of foetal trauma.
 Decreases the incidence of cord prolapse.
 Decreases the rate of unattended breech delivery.
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8. 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.
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9. Benefits to the mother
 Reduction in significant maternal complication
 Cs may compromise future reproduction.
 Emotional sequelae.
 Higher maternal death.
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10. 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.
 AF less than 2 cm in any pocket.
 Back of the foetus anteriorly.
 Maternal obesity.
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11. Indications
 Any breech after 36/40.
 Un-engaged breech.
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12. 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.
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13. Relative:
 Previous CS.
 IUGR.
 Severe protienuric PIH.
 RH iso-immunization.
 (Evidence of macrosomia).
 (Grand-multi-para).
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14.  (Anterior placenta).
 (Precious baby).
 (Previous APH).
 (Suspected foetal compromise).
 (Uterine anomaly).
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15. 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.
 IV line.
 Clinical pelvimetry.
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16. Procedure
 Position: -slight lateral tilt
 - trendelenburg.
 Tocolysis.
 One operator.
 Continuous pressure should be limited to 5 minutes.
 Dis-engagement of the breech.
 Forward or backward methods with flexion or slight
extension.
 CTG.
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17. 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.
 AFV was lower in the breech, 8 oligohydramnios to 1.
 Only 15% of the breech had identifiable cause.
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18. 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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