External Cephalic Version

Posted by e-Medical PPT
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.

Risks of ECV
Severe bradycardia requires immediate delivery by CS.
1% IUFD.
Spontaneous reversion.

Benefits to fetus
Decreases the risks of foetal trauma.
Decreases the incidence of cord prolapse.
Decreases the rate of unattended breech delivery.

Indications
Any breech after 36/40.
Un-engaged breech.

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.

Relative:
Previous CS.
IUGR.
Severe protienuric PIH.
RH iso-immunization.
(Evidence of macrosomia).
(Grand-multi-para).

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.

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