ECV - External Cephalic Version Version Spontaneous version...

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Unformatted text preview: External Cephalic Version 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. 12/24/11 External Cephalic Version 2 Promotion of spontaneous Promotion version version Any factor which promotes disengagement. Postural changes (Knee­chest position). 12/24/11 External Cephalic Version 3 ECV Before 1970: Performed without tocolysis. Prior to 36/40. With or without sedation. 12/24/11 External Cephalic Version 4 After 1978,after 36/40: Preferably with tocolysis. Lower incidence of complications Avoidance of PTL and delivery. 12/24/11 External Cephalic Version 5 Risks of ECV Severe bradycardia requires immediate delivery by CS. 1% IUFD. Spontaneous reversion. 12/24/11 External Cephalic Version 6 Results of meta-analysis Reduction in breech birth from 78% to 44%. Reduction in CS rate from 29% to 15%. 12/24/11 External Cephalic Version 7 Benefits to fetus Decreases the risks of foetal trauma. Decreases the incidence of cord prolapse. Decreases the rate of unattended breech delivery. 12/24/11 External Cephalic Version 8 Risks to the foetus Review of 979 cases: 8% bradycardia due to short term hypoxia. (49) 5% Feto­maternal haemorrhage with tocolysis and 285 (29%) without. 12/24/11 External Cephalic Version 9 Benefits to the mother Reduction in significant maternal complication Cs may compromise future reproduction. Emotional sequelae. Higher maternal death. 12/24/11 External Cephalic Version 10 Indications and contraindications 37/40 and above: Gestational age­37,38,40: 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. 12/24/11 External Cephalic Version 11 AF less than 2 cm in any pocket. Back of the foetus anteriorly. Maternal obesity. 12/24/11 External Cephalic Version 12 Indications Any breech after 36/40. Un­engaged breech. 12/24/11 External Cephalic Version 13 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. 12/24/11 External Cephalic Version 14 Relative: Previous CS. IUGR. Severe protienuric PIH. RH iso­immunization. (Evidence of macrosomia). (Grand­multi­para). 12/24/11 External Cephalic Version 15 (Anterior placenta). (Precious baby). (Previous APH). (Suspected foetal compromise). (Uterine anomaly). 12/24/11 External Cephalic Version 16 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. 12/24/11 External Cephalic Version 17 IV line. Clinical pelvimetry. 12/24/11 External Cephalic Version 18 Procedure Position: ­slight lateral tilt ­ trendelenburg. Tocolysis. One operator. Continuous pressure should be limited to 5 minutes. Dis­engagement of the breech. 12/24/11 External Cephalic Version 19 Forward or backward methods with flexion or slight extension. CTG. 12/24/11 External Cephalic Version 20 Maternal and foetal factors in Maternal breech 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. 12/24/11 External Cephalic Version 21 AFV was lower in the breech, 8 oligohydramnios to 1. Only 15% of the breech had identifiable cause. 12/24/11 External Cephalic Version 22 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. 12/24/11 External Cephalic Version 23 ...
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