Obstetrics and Gynaecology

External Cephalic Version Treatment

External Cephalic Version

When the woman is pregnant, long before she felt that first fluttery kick, the baby has been moving and grooving all over her womb. These usually keep up until the 36-week mark, when most of the babies strike their final pose. They get into a headfirst or cephalic position toward the opening of the birth canal. But sometimes 4% of the babies come out with bottom or feet first.

 

What is External Cephalic Version?

When the woman is pregnant, long before she felt that first fluttery kick, the baby has been moving and grooving all over her womb. These usually keep up until the 36-week mark, when most of the babies strike their final pose. They get into a headfirst or cephalic position toward the opening of the birth canal. But sometimes 4% of the babies come out with bottom or feet first. This makes vaginal birth difficult. The doctor may suggest turning the baby into the headfirst position with a procedure called an external cephalic version. The external cephalic version is a manual process by which a breech baby can be turned from foot or buttocks first to head first. It is generally done late in pregnancy, i.e., after 36 gestational weeks, but preferably 37 weeks, and can be performed even in the early labor. External cephalic Version is different from the "internal cephalic version", which involves insertion of a hand through the cervix.

Are There Reasons to Avoid an ECV?

An ECV is not required by everyone if the patient is expecting more than one baby at a time or if the patient needs a C-section for other health reasons. It is best for those women who have a pear-shaped womb and not with a heart-shaped womb, called a bicornuate uterus.

Other reasons the doctor might tell the mother not to get an ECV are:Page Image

  • If the patient has vaginal bleeding within 7 days of the procedure.
  • If the baby has an abnormal heartbeat or health problems.
  • If the patient’s water has broken.

How is an ECV performed?

An obstetrician puts their hands on the patient’s abdomen to turn their baby into a head-down position. A cardiotocograph or CTG will help in monitoring the baby’s wellbeing for 20-30 minutes before the procedure. A small needle will be inserted into the mother hand for relaxing their uterus. An obstetrician will then perform an ultrasound to know the position of the baby and will attempt to turn the baby by pressing their hands firmly on the abdomen. Some women may find this uncomfortable. The pressure on the abdomen only lasts for a few minutes. If the first attempt is unsuccessful, the obstetrician might try it again. The CTG might be applied again after the procedure to assess the baby’s wellbeing. It generally takes up to 3 hours.

Can anyone have an ECV?

External Cephalic Version is not recommended to those patients, who have:

  • a complicated pregnancy
  • twins or triplets
  • an unusually shaped uterus
  • had a cesarean section before
  • recently had vaginal bleeding
  • low levels of amniotic fluid
  • placenta praevia 
  • other health conditions can also hinder ECV, like high blood pressure or diabetes

ECV might also not be recommended if the unborn baby is unwell or is not growing well.

Success rates

ECV has a success rate of 75%. Various factors can affect the success rates of ECV. Maternal weight, practitioner experience, obstetric factors such as a palpable fetal head, uterine relaxation, non-anterior placenta, a non-engaged breech, and an amniotic fluid index above 7–10 cm, are the factors which can be associated with higher success rates during ECV. In addition, the effect of neuraxial blockade on ECV success rates has been conflicting, although ECV is easier to perform under the epidural block.

With the successful ECV, the baby head is turned; there is a less than 5% chance for the baby to turn spontaneously to breech again.

How It Works?

The baby's heartbeat will be monitored regularly with a cardiotocograph for about a half-hour before the ECV. In some of the cases, the patient may be given medicine through an IV for relaxing their uterus. This will not affect the baby. Then, by pressing her hands on the outside of the belly, the doctor will try to turn their baby. The goal is to get the baby to do a little flip in the womb and the baby will end up with head-down. The doctor may use an ultrasound to check their baby's position and guide the process.

Does It Hurt?

To turn the baby, the doctor will use a good amount of firm pressure. Every patient reacts differently, so they might feel discomfort or pain during this process.

Other methods to potentially turn my baby from a breech position

Some people think that the mother might be able to encourage their baby to turn by holding herself in certain positions, such as kneeling with their bottom in the air and held their head and shoulders flat to the ground. Other alternatives may include acupuncture, a Chinese herb called moxibustion and chiropractic treatment, there is no good evidence that these work. The patient must discuss every possible option with their doctor or midwife before undergoing any treatment during pregnancy.

What are the risks involved?

With frequent monitoring, the risks of the external cephalic version to the mother and her fetus are quite low.

Potential risks of ECV, for which the fetus and mother are closely monitored, may include:

  • Twisting or squeezing of the umbilical cord, reducing blood flow and flow of the oxygen to the fetus.
  • The beginning of labor, which can be caused due to the rupture of the amniotic sac around the fetus
  • Rupture of the uterus, placenta abruption, or damage to the umbilical cord.

In the rarest of cases, the labor begins or the fetus or mother develops a serious problem during version, an emergency cesarean section may be performed for delivering the fetus.

ECV has a small risk for causing bleeding that can result in the mixture of the blood of the mother and fetus. So a pregnant woman with Rh-negative blood is given an Rh immunoglobulin injection for preventing Rh sensitization, which can cause complications with the fetus in the future pregnancies. 

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