Treatment Overview

External cephalic version, or version, is a procedure used to revolve a fetus indigenous a breech place or side-lying (transverse) position right into a head-down (vertex) position before labour begins. Once successful, version renders it possible for friend to try a vaginal birth.

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Version is done most often prior to labour begins, typically around 37 weeks. Version is periodically used during labour prior to the amniotic sac has actually ruptured.

A booked caesarean is supplied to supply most breech births if a version doesn"t work.

Fetal monitoring

To avoid harm to the fetus, a variation procedure is carefully monitored.

Version procedure

Before the version attempt, you may be offered an injection of tocolytic medication to be sure the uterus and also prevent uterine contractions. The most typically used tocolytic medicine is terbutaline.

While the uterus is relaxed, your doctor will attempt to turn the fetus. Through both hands on the surface ar of your abdomen—one by the fetus"s head and also the various other by the buttocks—the medical professional pushes and rolls the fetus come a head-down position. You will feel discomfort during a variation procedure, especially if it causes the uterus to contract. The amount of discomfort relies on exactly how sensitive your abdomen is and how difficult the doctor presses on her abdomen during the version attempt. If her fetus appears to be in distress, as shown by a sudden drop in love rate, the procedure is stopped.

If a an initial attempt at variation is not successful in transforming the fetus, her doctor might suggest another attempt, probably with epidural anesthesia to assist you relax and also to minimize pain linked with the procedure. Epidural anesthesia may increase the success of repetitive version attempts.footnote 1

Serious complications space rare during external cephalic version. However they execute happen. This is why a variation is perform in a hospital wherein you deserve to have one emergency C-section delivery if needed.


What To suppose After Treatment

You and your fetus might be monitored because that a brief time after ~ a version attempt. You have the right to resume your normal tasks after the procedure is over.


Why that Is Done

Version might be attempted when:

The mom is 36 come 42 mainly pregnant. Before 36 weeks, a fetus is most likely to turn ago into a head-down position on that own. Yet version might be more successful if the is excellent as at an early stage as feasible after 36 weeks due to the fact that the fetus is smaller and also is surrounding by much more amniotic liquid and space to move in the uterus. The mother is pregnant with just one fetus. The fetus has not dropped right into the pelvis (has not engaged). A fetus the has engaged is very complicated to move. There is enough amniotic liquid surrounding the fetus for turning the fetus. If the quantity of amniotic liquid is below normal (oligohydramnios), the fetus is more likely to it is in injured throughout a version attempt. The mother has been pregnant before. A previous pregnant usually way that the wall of the abdomen is an ext flexible and also can stretch during a variation attempt. Variation may likewise be attempted if the mother has actually not to be pregnant before.

Version is usually not done when:

The bag of waters (amniotic sac) has ruptured. The mother has actually a problem (such together a love problem) that stays clear of her from receiving particular tocolytic medications to avoid uterine contractions. Fetal monitoring reflects that the fetus might not it is in doing well. The fetus has a hyperextended head. This means that the neck is straight, quite than bending the head forward v the chin tucked right into the chest. The fetus is recognized or doubt to have a bear defect. The mom is pregnant through multiple fetuses (twins, triplets, or more). The mother"s uterus does not have a typical shape.

Version might pose a slight hazard of opened a vault C-section scar. Minimal research data have displayed that women through a caesarean scar have had no such problems. Yet larger researches are needed to completely assess the risk.footnote 2

In part cases, a physician will pick not to shot a version when there is much less amniotic liquid than common (oligohydramnios) around the fetus.


How fine It Works

External cephalic version has actually an median success price of 58%.footnote 3 variation is most most likely to succeed when:footnote 4

The mommy has already had at least one pregnancy and childbirth. The fetus, or a foot or leg, has not to reduce down into the pelvis (has no engaged). The fetus is surrounding by a normal amount that amniotic fluid. The procedure is done close to term (36 or much more completed weeks of pregnancy), prior to labour starts.

Version is the very least likely to success when:footnote 4

The fetus is involved down in the mother"s pelvis. The physician cannot master the fetal head. The uterus is difficult or tense come the touch.

Compared come the very first attempt, repeat variation attempts are less likely to be successful.


Risks

With constant monitoring, the dangers of exterior cephalic version to the mother and also fetus space low.

Potential dangers of version, for which the fetus and also mother are very closely monitored, include:

The beginning of labour, which can be brought about by rupture the the amniotic sac approximately the fetus (premature rupture that the membranes, or PROM). Abruptio placenta, rupture of the uterus, or damages to the umbilical cord. The potential exists for such complications, however they are very rare.

In the rare instance that labour begins or the fetus or mother establishes a serious difficulty during version, an emergency caesarean ar (C-section) might be done to provide the fetus.

Version has a very tiny risk for bring about bleeding that might lead to mix of the blood that the mother and also fetus. So a pregnant woman with Rh-negative blood is provided an Rh immunoglobulin injection (such as RhoGAM) to prevent Rh sensitization, which can cause fetal symptom in future pregnancies.


What to Think About

In rare cases, inner version is offered to deliver a second twin or is used throughout labour when an emergency threatens the life of the fetus. In such a case, a medical professional tries to turn the fetus through reaching right into the uterus.


References

Citations


Credits


existing as of: February 11, 2020


Author: Healthwise Staff clinical Review: sarah Marshall MD - household Medicine catalen Romito MD - family Medicine Adam Husney MD - household Medicine william Gilbert MD - Maternal and also Fetal Medicine


Author: Healthwise Staff

Medical Review:Sarah Marshall MD - family Medicine & catalen Romito MD - household Medicine & Adam Husney MD - family members Medicine & wilhelm Gilbert MD - Maternal and Fetal Medicine


Klatt TE, Cruikshank DP (2008). Breech, other malpresentations, and umbilical cord complications. In RS Gibbs et al., eds., Danforth"s Obstetrics and also Gynecology, 10th ed., pp. 400-416. Philadelphia: Lippincott Williams and Wilkins.
American college of Obstetricians and Gynecologists (2000, reaffirmed 2012). Outside cephalic version. ACOG exercise Bulletin No. 13. Obstetrics and Gynecology, 95(2): 1-7.
American university of Obstetricians and also Gynecologists (2000, reaffirmed 2012). External cephalic version. ACOG exercise Bulletin No. 13. Obstetrics and also Gynecology, 95(2): 1-7.
Cunningham FG, et al. (2010). Breech presentation and also delivery. In Williams Obstetrics, 23rd ed., pp. 527-543. New York: McGraw-Hill.
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