51. External and internal version Flashcards
what are the different type of version ?
external version
internal version
bipolar version
what is the indication for external cephalic version ?
breech
transverse lie
describe the prerequests of external cephalic version
carried out after 36 weeks
tocolytic drug such as terbutaline SC can be administered if required
US used to confirm the fetal pole and amniotic fluid adequacy
a normal non stress test - which is the fetal heart rate
the patient is asked to empty her bladder
to lay on her back - with shoulders slightly raised and thighs slightly flexed
and in a slight lateral tilt for uteroplacental perfusion
carried out by experienced obstetricians
where there is readily available analgesia and c section
abtsiane from eating 6 hours before
intravenous line is placed for fluid or incase of emergency
the vulva is exposed to see if there is any bleeding
Immunoprophylaxis with anti-D gammaglobulin is to be administered in nonimmunized Rh-negative mother
describe the external cephalic version ?
IN BREECH
forward roll attempted
US guided
fetus buttocks is mobilised by using both hands at one iliac fossa
buttocks is grasped by the right and and while the head is grasped by the left hand
the pressure firm but not forcing is carried out on the buttocks toward s the fundus and the head towards the pelvis
the push should be intermittent and not all at one go until the head is brough to the lower pole of the pelviss
FHR is constantly checked
after ECV procedure what is obtained ?
A reactive NST should be obtained after completing the procedure
There may be undue bradycardia due to head compression which is expected to settle down by 10 minutes.
If however fetal bradycardia persists, possibility of cord entanglement should be kept in mind and in such cases reversion may have to be considered.
The patient is to be observed for about 30 minutes: (1) To allow the FHR to settle down to normal and (2) to note for any vaginal bleeding or evidence of premature rupture of the membranes.
what is external podalic version
it is done when the external cephalic version fails
causes of failure in external cephalic version
breech with extended legs—
Scanty liquor or big size baby.
obesity
Short cord
(5) Uterine malformations—septate or bicornuate.
what are the complications of external cephalic version ?
1) premature onset of labor,
(2) premature rupture of the membranes,
(3) placental abruption
(4) entanglement of the cord round the fetal part or formation of a true knot
(6) Amniotic fluid embolism.
contra for ECV?
placenta previa or abruption
Fetal causes—hyperextension of the head,
large fetus (> 3.5 kg),
congenital abnormalities (major),
IUGR
Multiple pregnancy
Contracted pelvis
Previous cesarean delivery—risk of scar rupture
Obstetric complications: Severe pre-eclampsia, obesity, elderly primigravida, oligohydramnios
internal version is always a ?
always a podalic version and is almost always completed with the extraction of the fetus.
indications of internal podalic version ?
Its only indication being the transverse lie in case of the second baby of twins.
it may be employed in extraordinary circumstances
what are the prerequisites for internal podalic version ?
The cervix must be fully dilated
(2) liquor amnii must be adequate for intrauterine fetal manipulation and
(3) fetus must be living
Assessment of the lie, presentation and FHR is made by an experienced obstetrician by abdominal palpation, vaginal examination and transabdominal ultrasound examination.
continuous FHR monitoring essential.
Internal version should be done under general or epidural anesthesia.
bladder should be empty ,
cervix must be atleast 3/4 dilated
membranes intact or just ruptured
describe the procedure of IPV?
if the podalic pole of the fetus is on the left side of the mother, the right hand is to be introduced and vice versa
keeping the back of the hand against the uterine wall until the hand reaches the podalic pole.
then along the thigh until a foot is grasped. both foot is ideally grasped
The identification of the foot is done by palpation of the heel.
While the feet is brought down by a steady traction, the cephalic pole is pushed up using the external hand to the fundus
The delivery is usually
completed with breech extraction
Routine exploration of the uterovaginal canal to exclude rupture of the uterus or any other injury.
complication of internal podalic version ?
Maternal risk includes placental abruption,
rupture of the uterus
The fetal risk includes asphyxia,
cord prolapse and
intracranial hemorrhage
when is bipolar version or braxton hicks version indicated ?
transverse lie in dead or premature fetus
