Treatment Overview

External cephalic version, or version, is a procedure used to turn a fetus native a breech place or side-lying (transverse) position into a head-down (vertex) position prior to labour begins. As soon as successful, version renders it possible for girlfriend to try a quality birth.

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Version is done many often before labour begins, typically about 37 weeks. Variation is sometimes used throughout labour prior to the amniotic sac has actually ruptured.

A scheduled caesarean is offered to deliver most breech births if a version doesn"t work.

Fetal monitoring

To avoid injury to the fetus, a version procedure is very closely monitored.

Version procedure

Before the variation attempt, you may be provided an injection that tocolytic medicine to relax the uterus and prevent uterine contractions. The most typically used tocolytic medicine is terbutaline.

While the uterus is relaxed, your physician will effort to rotate the fetus. V both hand on the surface ar of your abdomen—one through the fetus"s head and also the various other by the buttocks—the medical professional pushes and also rolls the fetus to a head-down position. You will feel discomfort during a variation procedure, especially if it reasons the uterus come contract. The amount of discomfort counts on just how sensitive her abdomen is and how tough the physician presses on your abdomen during the version attempt. If her fetus shows up to it is in in distress, as presented by a suddenly drop in heart rate, the procedure is stopped.

If a an initial attempt at version is not effective in turning the fetus, her doctor might suggest an additional attempt, probably with epidural anesthesia to aid you relax and also to mitigate pain associated with the procedure. Epidural anesthesia may increase the success of repetitive version attempts.footnote 1

Serious complications room rare during external cephalic version. However they carry out happen. This is why a variation is carry out in a hospital wherein you have the right to have one emergency C-section delivery if needed.


What To expect After Treatment

You and also your fetus might be monitored for a quick time after ~ a variation attempt. You have the right to resume her normal tasks after the procedure is over.


Why the Is Done

Version may be attempted when:

The mom is 36 to 42 mainly pregnant. Before 36 weeks, a fetus is most likely to turn ago into a head-down place on that own. Yet version might be more successful if it is done as beforehand as feasible after 36 weeks due to the fact that the fetus is smaller and is surrounded by an ext amniotic fluid and an are to relocate in the uterus. The mommy is pregnant with just one fetus. The fetus has not dropped right into the pelvis (has not engaged). A fetus that has involved is very an overwhelming to move. Over there is sufficient amniotic liquid surrounding the fetus for turning the fetus. If the lot of amniotic fluid is below normal (oligohydramnios), the fetus is an ext likely to be injured during a variation attempt. The mother has been pregnant before. A previous pregnant usually means that the wall of the abdomen is much more flexible and can stretch throughout a variation attempt. Version may also be test if the mother has not been pregnant before.

Version is typically not excellent when:

The bag the waters (amniotic sac) has ruptured. The mother has actually a problem (such as a heart problem) that prevents her native receiving details tocolytic drugs to avoid uterine contractions. Fetal monitoring reflects that the fetus might not it is in doing well. The fetus has a hyperextended head. This method that the neck is straight, rather than bending the head forward with the chin tucked into the chest. The fetus is known or doubt to have a bear defect. The mother is pregnant through multiple fetuses (twins, triplets, or more). The mother"s uterus does not have a regular shape.

Version might pose a slight threat of opened a ahead C-section scar. Minimal research data have shown that women with a caesarean scar have had actually no together problems. Yet larger studies are required to completely assess the risk.footnote 2

In part cases, a medical professional will choose not to shot a version when there is much less amniotic fluid than common (oligohydramnios) approximately the fetus.


How fine It Works

External cephalic version has an typical success rate of 58%.footnote 3 variation is most likely to success when:footnote 4

The mother has currently had at least one pregnancy and childbirth. The fetus, or a foot or leg, has actually not dropped down into the pelvis (has not engaged). The fetus is surrounded by a regular amount the amniotic fluid. The procedure is done close to term (36 or an ext completed mainly of pregnancy), prior to labour starts.

Version is the very least likely to succeed when:footnote 4

The fetus is engaged down in the mother"s pelvis. The doctor cannot understand the fetal head. The uterus is hard or tense come the touch.

Compared come the an initial attempt, repeat version attempts are less likely to be successful.


Risks

With constant monitoring, the dangers of outside cephalic version to the mother and also fetus room low.

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

The beginning of labour, which have the right to be brought about by rupture of the amniotic sac about the fetus (premature rupture of the membranes, or PROM). Abruptio placenta, rupture that the uterus, or damage to the umbilical cord. The potential exists because that such complications, however they are really rare.

In the rare case that labour begins or the fetus or mother creates a serious difficulty during version, one emergency caesarean section (C-section) may be done to provide the fetus.

Version has actually a very tiny risk for leading to bleeding that could lead to mix of the blood of the mother and fetus. So a pregnant woman v Rh-negative blood is provided an Rh immunoglobulin injection (such together RhoGAM) to prevent Rh sensitization, i m sorry can reason fetal complications in future pregnancies.


What come Think About

In rarely cases, interior version is offered to supply a 2nd twin or is used during labour once an emergency intimidates the life that the fetus. In such a case, a medical professional tries to rotate the fetus by reaching right into the uterus.


References

Citations


Credits


current as of: might 29, 2019


Author: Healthwise Staff medical Review: buy it Marshall MD - family members Medicine catalent Romito MD - household Medicine Adam Husney MD - family members Medicine william Gilbert MD - Maternal and also Fetal Medicine


Author: Healthwise Staff

Medical Review:Sarah Marshall MD - family Medicine & kathleen Romito MD - household Medicine & Adam Husney MD - family members Medicine & william Gilbert MD - Maternal and also Fetal Medicine


Klatt TE, Cruikshank DP (2008). Breech, other malpresentations, and umbilical cord complications. In RS Gibbs et al., eds., Danforth"s Obstetrics and Gynecology, 10th ed., pp. 400-416. Philadelphia: Lippincott Williams and also Wilkins.
American university of Obstetricians and Gynecologists (2000, reaffirmed 2012). Outside cephalic version. ACOG practice Bulletin No. 13. Obstetrics and Gynecology, 95(2): 1-7.
American college of Obstetricians and Gynecologists (2000, reaffirmed 2012). External cephalic version. ACOG practice Bulletin No. 13. Obstetrics and also Gynecology, 95(2): 1-7.
Cunningham FG, et al. (2010). Breech presentation and also delivery. In Williams Obstetrics, 23rd ed., pp. 527-543. Brand-new York: McGraw-Hill.
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