Upload
reedoye21
View
231
Download
0
Embed Size (px)
Citation preview
8/4/2019 ECV by Abhishek Jaguessar
1/23
External Cephalic
VersionBY
ABHISHEKJAGUESSAR
8/4/2019 ECV by Abhishek Jaguessar
2/23
4/13/2012 2External Cephalic Version
Spontaneous version
After 32/40 is as high as 57% andafter 36/40 may still be as high as 25%.
Is more in multiparous. Less likely in primipara and extended
breech.
8/4/2019 ECV by Abhishek Jaguessar
3/23
4/13/2012 3External Cephalic Version
Promotion of spontaneousversion
Any factor which promotesdisengagement.
Postural changes (Knee-chest position).
8/4/2019 ECV by Abhishek Jaguessar
4/23
4/13/2012 4External Cephalic Version
ECV
Before 1970:
Performed without tocolysis.
Prior to 36/40. With or without sedation.
8/4/2019 ECV by Abhishek Jaguessar
5/23
4/13/2012 5External Cephalic Version
After 1978,after 36/40:
Preferably with tocolysis.
Lower incidence of complications Avoidance of PTL and delivery.
8/4/2019 ECV by Abhishek Jaguessar
6/23
4/13/2012 6External Cephalic Version
Risksof ECV
Severe bradycardia requires immediatedelivery by CS.
1% IUFD. Spontaneous reversion.
8/4/2019 ECV by Abhishek Jaguessar
7/234/13/2012 7External Cephalic Version
Results of meta-analysis
Reduction in breech birth from 78% to44%.
Reduction in CS rate from 29% to 15%.
8/4/2019 ECV by Abhishek Jaguessar
8/23
4/13/2012 8External Cephalic Version
Benefits to fetus
Decreases the risks of foetal trauma.
Decreases the incidence of cordprolapse.
Decreases the rate of unattendedbreech delivery.
8/4/2019 ECV by Abhishek Jaguessar
9/23
4/13/2012 9External Cephalic Version
Risks to the foetus
Review of 979 cases:
8% bradycardia due to short termhypoxia.
(49) 5% Feto-maternal haemorrhagewith tocolysis and 285 (29%) without.
8/4/2019 ECV by Abhishek Jaguessar
10/23
4/13/2012 10External Cephalic Version
Benefits to the mother
Reduction in significant maternalcomplication
Cs may compromise future reproduction.
Emotional sequelae.
Higher maternal death.
8/4/2019 ECV by Abhishek Jaguessar
11/23
4/13/2012 11External Cephalic Version
Indications and contra-indications
37/40 and above:
Gestational age-37,38,40: 40 moresuccessful than 39,38 more than 37.
EFW: the bigger the foetus the lesssuccessful ECV.
Tense abdomen/uterus. Difficulty in palpating the foetal head.
Increasing parity.
8/4/2019 ECV by Abhishek Jaguessar
12/23
4/13/2012 12External Cephalic Version
AF less than 2 cm in any pocket.
Back of the foetus anteriorly.
Maternal obesity.
8/4/2019 ECV by Abhishek Jaguessar
13/23
4/13/2012 13External Cephalic Version
Indications
Any breech after 36/40.
Un-engaged breech.
8/4/2019 ECV by Abhishek Jaguessar
14/23
4/13/2012 14External Cephalic Version
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 acquiredheart disease, DM or thyroid disease.
8/4/2019 ECV by Abhishek Jaguessar
15/23
4/13/2012 15External Cephalic Version
Relative:
Previous CS.
IUGR. Severe protienuric PIH.
RH iso-immunization.
(Evidence of macrosomia). (Grand-multi-para).
8/4/2019 ECV by Abhishek Jaguessar
16/23
4/13/2012 16External Cephalic Version
(Anterior placenta).
(Precious baby).
(Previous APH). (Suspected foetal compromise).
(Uterine anomaly).
8/4/2019 ECV by Abhishek Jaguessar
17/23
4/13/2012 17External Cephalic Version
Pre-requisites
USS to confirm normal baby and normalAFV.
Reactive CTG.
Informed concent: PTL, ROM,cord andplacental accident.
Facilities for immediate CS. Kleihauer test.
8/4/2019 ECV by Abhishek Jaguessar
18/23
4/13/2012 18External Cephalic Version
IV line.
Clinical pelvimetry.
8/4/2019 ECV by Abhishek Jaguessar
19/23
4/13/2012 19External Cephalic Version
Procedure
Position: -slight lateral tilt
- trendelenburg.
Tocolysis. One operator.
Continuous pressure should be limited to
5 minutes. Dis-engagement of the breech.
8/4/2019 ECV by Abhishek Jaguessar
20/23
4/13/2012 20External Cephalic Version
Forward or backward methods withflexion or slight extension.
CTG.
8/4/2019 ECV by Abhishek Jaguessar
21/23
4/13/2012 21External Cephalic Version
Maternal and foetal factors inbreech
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.
8/4/2019 ECV by Abhishek Jaguessar
22/23
4/13/2012 22External Cephalic Version
AFV was lower in the breech, 8oligohydramnios to 1.
Only 15% of the breech had identifiablecause.
8/4/2019 ECV by Abhishek Jaguessar
23/23
4/13/2012 23External Cephalic Version
Conclusion
Current evidence indicates that ECVperformed at term with tocolysis issafe procedure for carefully selected
cases. The short term complications are
negligible and the long term ones are
hard to determine.