Ecv- External Cephalic Version- Define, Risk, procedure, step, benefits PPT

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. Risksof 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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