| External cephalic version | |
|---|---|
| Intervention | |
| ICD-9-CM | 73.91 |
External cephalic version is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. It is usually performed after about 37 weeks.[1] It is often reserved for late pregnancy because breech presentation greatly decreases with every week.
It can be contrasted with "internal cephalic version", which involves the hand inserted through the cervix.[2]
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In this procedure hands are placed on the mother's abdomen around the baby. The baby is moved up and away from the pelvis and gently turned in several steps from breech, to a sideways position, and finally to a head first presentation.
Use of intravenous nitroglycerin has been proposed.[3]
As with any procedure there can be complications most of which can be greatly decreased by having an experienced professional on the birth team. An ultrasound to estimate a sufficient amount of amniotic fluid and monitoring of the fetus immediately after the procedure can also help minimize risks.
Typical risks include umbilical cord entanglement, abruptio placenta, preterm labor, premature rupture of the membranes (PROM) and severe maternal discomfort. Overall complication rates have ranged from about 1 to 2 percent since 1979. While somewhat out of favor between 1970 and 1980, the procedure has seen an increase in use due to it's relative safety. Before 1980, four fetal deaths were reported with ECV, all of which involved general anesthesia. After 1980, only two deaths have been reported, both occuring in Zimbabwe without fetal heart monitoring or ultrasound. [4]
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