ECV GTG Flashcards
How common is breech?
3-4% term deliveries
Success rates ECV multiple and primip
Multi 60%
Primip 40%
What % failed ECG will spont turn to cephalic?
8%
What % revert to breech after ECV?
3%
What factors make ECV more likely to be successful?
Multip
Non-engagement
Tocoloysis
Mat weight <65kg
Posterior placenta
Complete breech position
AFI >10
What medication can you give for tocolysis?
250mcg salbutamol in 25ml saline slow IV
250mcg terbutaline
What type of drugs is terbutaline?
β₂ adrenergic receptor agonist
Who should terbutaline not be given to?
- Placental abruption
- APH
- Eclampsia
- Hx cardiac disease
- IUD
- Intrauterine infection
- Risk MI
Not effective if taking beta-blockers
When should ECV be offered?
From 37 weeks, can be considered at 36 weeks for primips.
Contraindications to ECV:
Placental abruption, severe PET, abnormal doppler or CTG, absolute reason for CS already exsists (Placenta praevia), multiple pregnancy (except after delivery of first baby), rhesus isoimmunisation, current or recent (< 1 week) vaginal bleeding, abnormal CTG, rupture of membranes, mother decline
Caution: Oligo or HTN
Can it be offered to women with previous CS?
Women should be informed that ECV after 1 CS appears to have no greater risk than an unscarred uterus
Risk of EMCS within 24hrs of ECV
0.5%
Normally due to abnormal CTG or PVB
What are the maximum number of attempts for ECV?
4 attempts, max 10 mins overall
If patient rhesus negative?
Give anti-D within 72 hours 500IU and kleiheurs
How sensitive is abdominal examination for breech presentation?
70%
What is the recurrence rates of breech?
10% - should have USS at 36 weeks
If successful ECV, any impacts on labour outcomes?
Higher rates of CS and instrumental
Can ECV be offered for unstable lie?
Yes but IOL immediately after
What is the rates of perinatal mortality in vaginal breech and ELCS for breech?
Vaginal breech: 2/1000
(Normal birth 1/1000)
ELCS 0.5/1000
EMCS is need in what % vaginal breech deliveries?
40%
What risk factors are more likely to make vaginal breech less likely?
Hyperextended neck on ultrasound
High estimated fetal weight (more than 3.8 kg)
Low estimated weight (less than tenth centile)
Footling presentation
Evidence of antenatal fetal compromise.
If identified offer CS
In what situation can vaginal breech be considered for augmentation?
IOL not normally recommended
Can be considered Regional anaesthesia and slow contraction
