Wednesday, July 5, 2017

External Cephalic Version : An overview

Here's a short review on basics of External Cephalic Version.
So this Procedure is basically manipulating the baby externally to come in a favorable cephalic presentation.
Its indications need are limited and mainly include -
Breech Presentation and Transverse Lie.
The most important thing to remember is when not to do an ECV.
You can remember these contraindications as :
ABCDEF
A - Ante partum hemorrhage ( Previa and Abruptio.) It can result in detachment and more Accidental Hemorrhage (Abruption).
B - Bad Obstetric History
C -
Contracted Pelvis - ECV can cause fetal Hypoxia if the pelvis is small already
Congenital uterine Abnormalities - like bicornuate etc as can cause uterine rupture.
D - Dual Pregnancy (Twins/ Multifetal pregnancy).
E - Eclampsia PIH.
F - Fluid - Oligohydramnios
2 other C/I are important to remember -
Previous Cesarean section ( Uterine rupture chances are high).
Rh Incompatibility.
The best time for doing an ECV is around 36-38 weeks. It's easiest to perform the maneuver before 36 weeks but the fetus undergoes a lot of spontaneous movements before 36 weeks and may come back to being Breech.
Beyond 40 weeks best to avoid it as liquor reduces in amount and can cause cord compression amongst other things.
Another pre requisite is having the uterus relaxed. So it may be done in OT set up where anesthesia like Halothane can be used as a uterine relaxant. (Not so sure about the last part as some PG resident in college told us this. :P)
Hope this helps.
Happy Studying !
And as always ,
Stay Awesome !
~ A.P.Burkholderia.

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