External cephalic version (ECV) is usually performed in a labor and delivery unit, with an operating room and resources available to perform emergency cesarean delivery if and when necessary. The fetal and maternal status are continuously monitored. A bedside ultrasound is usually done prior to assessing the fetal position, amniotic fluid level, placenta location, and uterine cavity shape to determine if the procedure can be performed and the expected success rate. Tocolytics (medications to suppress premature labor) and/or regional anesthesia (such as an epidural) may be administered to women who are to undergo ECV. During ECV, the doctor places their hands on the maternal abdomen and gently turns the fetus from breech to cephalic presentation. Ultrasound gel is usually applied over the maternal abdomen to help the doctor’s hand glide easily. If only one doctor is performing ECV, they would place one hand on the fetal head and the other over fetal buttocks and slowly turn the fetus.
If two doctors are performing ECV together, one doctor controls the fetal head, and the other doctor controls the fetal buttocks.
Factors that increase the success rate of ECV include:
- Multiparity (history of more than one pregnancy)
- Non Engagement (non-fixation) of the presenting fetal part into the maternal pelvis
- Relaxed uterus
- Palpable fetal head
- Maternal weight under 65 kg
- Increased amniotic fluid
- Posteriorly lying placenta
- Lateral (right or left sided) lying fetal spine position
- Complete breech fetal presentation
- Gestational age above 36 weeks
- Complete breech presentation
Factors that reduce the success rate of ECV include:
- Nulliparity (first pregnancy)
- Firm maternal abdominal muscles
- Tense uterus
- Anterior (forward) lying placenta
- Decreased amniotic fluid
- Ruptured membranes
- Low fetal birth weight
- Presenting fetal part engaged (fixed) into the maternal pelvis
- Maternal obesity
- Nonpalpable fetal head
- Posteriorly located fetal spine
- Low fetal abdominal circumference below the fifth percentile
What is the external cephalic version?
External cephalic version (ECV) is a procedure in which an attempt is made by the doctor to shift the fetus while still in the uterus. It is done by putting external pressure on the swollen belly. The goal of the procedure is to change the presentation of the fetus from breech to cephalic. ECV is done by the doctor by placing their hands on the maternal abdomen and gently turning the fetus while continuously monitoring the fetus and mother.
Cephalic presentation or vertex presentation is when the head of the fetus is at the uterine mouth at the time of childbirth. The head enters the pelvis first. Cephalic presentation of the fetus is preferred at term because it is associated with lesser risks and mortality to the baby during delivery. Cephalic presentation reduces the need for cesarean delivery.
Breech presentation is when the fetus lies longitudinally, with the buttocks or feet closest to the cervix. Breech presentation occurs in 3-4% of all deliveries. There is an increased risk of perinatal mortality with breech presentation. Fetal death is often associated with fetal malformations, prematurity, and intrauterine death. Hence, more than 90% of breech fetuses are delivered by elective (planned) cesarean delivery. If vaginal delivery is attempted, the doctor may have to convert it to cesarean delivery if the former fails.
Types of breech presentations:
- Frank breech (50-70%): The fetus is in a pike position (the hips are flexed and the knees are extended).
- Complete breech (5-10%): The fetus is in a cannonball position (the hips and knees are flexed).
- Footling or incomplete breech (10-30%): One or both the hips are extended with the foot presenting.
Why is the external cephalic version done?
External cephalic version (ECV) has proven to be a valuable maneuver to reduce the rate of cesarean delivery by reducing the incidence of breech presentation at term. If the patient is an ideal candidate for ECV, the procedure is a safe and effective way to convert fetuses from breech to cephalic presentation to try to avoid cesarean delivery. Cesarean delivery is associated with a high risk of maternal morbidity and mortality. Hence, ECV is usually offered to all near-term women with breech presentation who do not have any contraindications to the procedure to increase their chances of having a safe cephalic vaginal delivery.
When is the external cephalic version not done?
External cephalic version (ECV) is usually contraindicated if the procedure would put the fetus or mother at risk of life-threatening complications or if the procedure is not likely to succeed.
ECV may not be performed in the following conditions:
- Placenta previa (low-lying placenta covering the cervix)
- Abruptio placenta (the placenta detaches from the uterus before delivery)
- Poor fetal health status
- Intrauterine growth restriction (IUGR)
- Abnormal umbilical artery
- Maternal hypertension
- Fetal abnormalities such as neck mass
- History of recent vaginal bleeding during pregnancy
- Anatomical uterine abnormalities
- Uterine pathologies such as uterine fibroids
- Ruptured membranes (referred to as water breaking)
- Hyperextended head of the fetus in the uterus
- Multiple gestations (more than one fetus, such as twins or triplets)
Relative contraindications include:
- Maternal obesity
- A fetus that is small for gestational age
- Oligohydramnios (decreased amniotic fluid in the uterus)
- Uterine scarring from previous cesarean delivery or other surgeries performed to treat uterine pathologies
SLIDESHOW
Conception: The Amazing Journey from Egg to Embryo See SlideshowHealth Solutions From Our Sponsors
https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf
https://www.acog.org/womens-health/faqs/if-your-baby-is-breech
Top How Is External Cephalic Version Done? Related Articles
Childbirth Delivery Methods and Types
Learn about the pros and cons of various childbirth methods, such as the Bradley method, C-section, natural childbirth, water birth, Lamaze, and vaginal delivery. Read about birthing centers, hospital and home births, midwives, and doulas.
Braxton Hicks Contractions (False Labor)
Braxton Hicks contractions are also known as false labor pains. Though these irregular uterine contractions may occur in the second trimester, they're more likely to occur during the third trimester of pregnancy. Unlike true labor pains, false labor pains are often irregular, may stop when you walk, rest, or change positions, and the contractions do not get closer together or stronger.
Braxton Hicks vs. True Labor: How to Tell the Difference
Some pregnant women may mistake Braxton Hicks contractions (false labor) for real labor contractions, especially in the first pregnancy. Real labor contractions occur at regular intervals that become progressively shorter; more painful as labor progresses; are described as a tightening, pounding, or stabbing pain. Braxton Hicks contractions do not occur in regular intervals; do not become longer over time; and may disappear for a period of time and then return. Braxton Hicks contractions occur in third trimester of pregnancy, however, sometimes can occur in the second trimester. True labor contractions begin around your due date (unless your baby is preterm, in which you will be in preterm labor). So how can you tell the difference? Here are a few similarities and differences between Braxton Hicks contractions and True or real labor contractions.Braxton Hicks contractions
Braxton Hicks contractions tend to become more frequent toward the end of pregnancy, and are not as painful as real labor contractions; do not occur in regular intervals; do not become longer over time; and may disappear for a period of time and then return.
Labor contractions
Frequently one of the early symptoms and signs of true labor is when the contractions begin to occur less than 10 minutes apart.
Real labor
Real labor contractions occur at regular intervals that become progressively shorter; more painful as labor progresses; are described as a tightening, pounding, or stabbing pain; may feel similar to menstrual cramps; and sometimes Braxton Hicks contractions can be triggered by dehydration, sexual intercourse, increased activity of the mother or baby, touching of the pregnant woman's abdomen, or a distended bladder.
Natural and home remedies to soothe and provide comfort for Braxton Hicks contractions include relaxation exercises like deep breathing or mental relaxation; change positions or take a walk if you have been active and rest; drink a glass of herbal tea or water; eat; or soak in a warm bath for 30 minutes (or less).
Preterm labor signs and symptomsWhen you have reached 37 weeks, and the contractions are more painful and are increasing in frequency you will have abdominal pain or menstrual-like cramping, an increase in pelvic pressure or back pain, and the contractions are more than four contractions an hour.
Labor Symptoms (Early Signs)
Every woman's experience with labor and delivery is unique for each woman, and thus "Normal" labor varies from woman to woman. Some of the common signs and symptoms of normal labor include the "baby dropping," increase urination, back pain, contractions, and diarrhea.
Labor and Delivery
Early and later symptoms and signs of labor and delivery are unique to each woman. Early signs of labor are "lightning" and passing the mucus plug. Later symptoms and signs that labor that labor is are the woman's water breaking, and when contractions begin. There are three stages of labor, stage 1 is the longest and occurs when the cervix begins to thin and dilate. During stage 2 of labor the baby passes through the birth canal and remains there until delivery, and stage 3, is when the baby is delivered.
How Long Does It Take to Go Into Labor After Being Induced?
The time it takes to go into labor after being induced can take anywhere from a few hours to 2-3 days. Learn what to expect when inducing labor. Check out the center below for more medical references on labor and childbirth, including multimedia (slideshows, images, and quizzes), related diseases, treatment, diagnosis, medications, and prevention or wellness.
Stages of Pregnancy: Week by Week
See pictures on the various stages of pregnancy. See and learn what changes a woman's body goes through and view fetal images of how her baby grows during the 1st, 2nd and 3rd trimesters.
What Are the Side Effects of Cesarean Delivery?
Cesarean delivery is a surgery to deliver a baby through a surgical cut (incision) on the abdomen and uterus. It is generally a safe procedure for the mother and baby. There may, however, be a few risks to the health of the mother and baby. These risks are described below.
What Are the Side Effects of Vacuum Delivery?
Vacuum delivery is a type of assisted birth delivery also called ventouse-assisted delivery. Vacuum-assisted birth is a method to assist the delivery of a baby using a vacuum device. The side effects include potential risks to the mother and risks to the baby.
What Is the Process of Normal Delivery?
Normal delivery refers to childbirth through the vagina without any medical intervention. It is also known as a vaginal birth. Every delivery is unique and may differ from mothers to mothers. There are different stages of normal delivery or vaginal birth.
When Can You Have a VBAC After Cesarean Delivery?
VBAC stands for vaginal birth after cesarean. If a woman has delivered a baby by Cesarean delivery and she is pregnant again, she may be able to choose between delivering through a repeat Cesarean delivery or a vaginal birth after cesarean (VBAC).Why Is Forceps Delivery Done?
Forceps delivery is a type of assisted delivery in which tong-shaped instruments are used to ease the baby out of the birth canal. These instruments are used to cradle the baby’s head in the vagina and turn the baby into a better position if needed so that they can be guided out.