2017 20a ECV Flashcards
** How effective is ECV in preventing breech birth? **
- 50% overall ECV success
- 60% for multiparous
- 40% for nulliparous
- If unsuccessful, few spontaneously turn to cephalic (3-8%)
- If successful, few revert to breech (3%)
** How does ECV impact on mode of birth? **
- Successful ECV reduces chance of CS
- Slightly increased risk of CS & OVB after ECV vs spontaneous cephalic, for obstructed labour or fetal distress
** Can the success of an ECV attempt be predicted? **
To some extent, but prediction models should not be routinely used
** What methods can be used to improve the success rate of ECV? **
- Tocolysis with betamimetics
- Routine regional analgesia or neuraxial blockade not recommended but can be considered for repeat/intolerant
** At what gestation should ECV be offered? **
- Multiparous: 37/40
- Nulliparous: 36/40
** How risky is ECV? **
- Very low complication rate if appropriate precautions
- No general consensus on contraindications
- 1 previous CS: no greater risk than unscarred
** What measures ensure fetal safety with ECV? **
- Perform with facilities for monitoring & surgical delivery
- Do not need to make preoperative CS preparations
- EFM recommended post-ECV
- If D negative, offer anti-D 500u within 72h & test for feto-maternal haemorrhage
** What is the role of non-ECV methods for turning breech? **
- Moxibustion can be considered at 33-35/40 under trained practitioner
- No evidence for postural management alone
** What is the epidemiology of breech presentation? **
3-4% of term deliveries
More common in nulliparity & preterm
What factors improve ECV success rates?
- Multiparity
- Non-engagement of breech
- Tocolysis
- Palpable fetal head
- Maternal weight <65kg
- Posterior placenta
- Complete breech
- AFI>10
What tocolytics are recommended for ECV?
- Terbutaline 250 μg SC
- Salbutamol 250 μg in 25ml saline, 10 μg/ml, by slow IV
- No good evidence for nifedipine, atosiban or GTN
When should betamimetics not be used in ECV?
- Significant cardiac disease
- Severe hypertension
- Using beta blockers
What are the side effects of terbutaline?
- Maternal palpitations
- Tachycardia
- Flushing
- Tremor
- Nausea
What are the contraindications to ECV?
- Placental abruption
- Severe PET
- Abnormal fetal Doppler or CTG
- Alternative absolute indication for CS
- Multiple pregnancy
- Rhesus isoimmunisation
- Current or within 1 week PVB
- Rupture of membranes
- Mother declines or can’t consent
What is the risk of emergency CS within 24 hours following ECV?
0.5%
