ECV and Reducing Term Breech Flashcards
What proportion of babies are breech at term?
3-4%
(more common in pre-term and primips).
What is the re-occurence rate for breech presentation?
10%
What is the success rate of ECV?
(overall, in multips and in nullips)
Overall success = 50%
Multips success = 60%
Nullips success = 40%
What is the rate of spontaneous cephalic version in primips, after 36/40?
8%
5 factors that increase the success rate of ECV
- Multiparity
- Non-engagement of the breech
- Use of tocolysis
- Palpable foetal head
- Malternal weight <65kg
What is the rate of spontaneous cephalic version after an unsuccessful ECV?
3-7%
What is the chance of babies reverting to breech presentation after a successful ECV?
3%
What tocolysis is used during an ECV?
What are the contra-indications to this type of tocolysis?
Betamimetics (250microg salbutamol or 250microg terbutaline).
CI if significant cardiac disease and not effective if taking beta blockers.
Can Nifedipine or Atosiban be used as tocolysis for ECV?
There is no evidence for use of Nifedipine.
There is insufficient data for Atosiban.
What is the role of anasthetic and neuroaxial blocks in ECV?
Routine use should be avoided, but if re-attempting ECV, both of these can be considered.
When should ECV be offered?
From 36/40 in nullips.
From 37/40 in multips.
What are the contra - indications for ECV?
Known abruption
Severe PET
Abnormal CTG Doppler
Absolute reason patient should have LSCS (e.g. previa)
Rhesis immunisation (<1 week ago)
PVB
PROM/SROM
Previous LSCS (after 1LSCS there appears to be the same risk as unscared uterus, but only one small scale study).
Caution in HTN and Oligohydramnios.
What are the risks of ECV?
2.4% risk of foeto-maternal haemorrhage of 1-30mls.
0.5% risk of EmLSCS within 24 hours (90% of those due to PVB or abnormal CTG).
Placental abruption/ large fetomaternal haemorrhage (only case reports).
What measures should be taken before carrying out an ECV?
- Anti-D if Rh negative (max 500IU within 72 hours, depending on Kleihauer).
- EFM before and after procedure.
- USS before and after to asses FH (note that transient 3 minute bradycarida is common, but LSCS if 6+ mins).
What is the difference in APGAR scores between babies who have had an ECV vs ElLSCS?
No difference in APGAR scores.
What is the maximum time / number of attempts that an ECV should be carried out?
10 minutes
4 attempts
What proportion of women decline an ECV?
9%
Increased uptake if early identification and time to discuss/understand options.
What proportion of women report significant pain during an ECV?
33%
What is the sensitivity of abdominal palpation in detecting breech presentation?
70%
What is the alternative to ECV?
- ElLSCS
- Moxibustion (burning Mugwort leaves at 33-35/40 under professional supervision).
(no evidence for changing maternal position)
What are the effects of ECV on labour?
- Reduces risk of LSCS (higher chance if shorter ECV to delivery time).
- Overall slightly higher risk of instrumental or LSCS (obstructed labour or foetal distress).
What is the maximum time in which a vaginal breech baby should be delivered from the breech on the perineum to the head?
Total 7 minutes.
3 minutes from scapulae to head delivery.
What factors increase risk during planned vaginal breech delivery?
Hyperextended neck
EFW>3.8kg
EFW<10th centile
Footling presentation
Evidence of antenatal foetal compromise.
What is the perinatal mortality associated with:
- breech vaginal delivery?
- cephalic vaginal delivery?
- LSCS delivery (from 39/40)?
Breech - 2 / 1,000
Cephalic - 1 / 1, 000
LSCS - 0.5 / 1, 000
