01958 Anesthesia for external cephalic version procedure

Name of the Procedure:

Anesthesia for External Cephalic Version (ECV) Procedure

Summary

Anesthesia for an External Cephalic Version (ECV) involves administering medication to manage pain and discomfort while a healthcare professional attempts to turn a breech baby to the head-down position before delivery.

Purpose

The procedure addresses the issue of breech presentation, where the baby is positioned feet or buttocks first rather than head first. The goal is to increase the chances of a vaginal birth and reduce the likelihood of a cesarean section.

Indications

• Breech presentation after 36-37 weeks of pregnancy.
• Singleton pregnancy (one baby).
• No contraindications to vaginal delivery like placenta previa or cord prolapse.

Preparation

• Fasting for 6-8 hours prior to the procedure.
• Review of maternal and fetal health records.
• Ultrasound to confirm the baby's position and amniotic fluid volume.
• Possible blood tests and non-stress tests to ensure fetal well-being.

Procedure Description

1. The patient is positioned comfortably, usually lying on her back.
2. Administration of anesthesia, typically an epidural or spinal, to provide pain relief.
3. Ultrasound guidance to monitor the baby’s position.
4. The healthcare provider manually applies pressure to the abdomen to gently turn the baby to the head-down position.
5. Continuous monitoring of the baby's heart rate and the mother's condition throughout the procedure.

Duration

The complete ECV procedure typically takes about 1 hour.

Setting

The procedure is performed in a hospital setting, specifically in a labor and delivery suite or an obstetric unit.

Personnel

• Obstetrician
• Anesthesiologist
• Nurses
• Ultrasound technician

Risks and Complications

• Temporary changes in fetal heart rate.
• Discomfort or pain despite anesthesia.
• Preterm labor.
• Premature rupture of membranes.
• Placental abruption.
• Rare risk of emergency cesarean section.

Benefits

• Increased likelihood of a vaginal birth.
• Decreased need for cesarean section.
• Reduced surgical risks associated with cesarean delivery.
• Shorter recovery times compared to cesarean section.

Recovery

• Post-procedure monitoring for fetal heart rate and maternal well-being.
• Instructions to report any signs of labor or complications immediately.
• Typically, patients can go home the same day if there are no complications.
• Follow-up appointment with the obstetrician.

Alternatives

• Planned cesarean section.
• Attempting vaginal breech delivery (less common and subject to specific criteria).
• Pros: Cesarean section eliminates risks of failed ECV and acute complications. Cons: Surgical risks and longer recovery from cesarean section compared to successful vaginal delivery.

Patient Experience

• The patient will feel abdominal manipulation but should not experience significant pain due to anesthesia.
• Occasional discomfort and a feeling of pressure as the baby is turned.
• Post-procedure soreness in the abdomen.
• Pain management options like mild pain relievers and comfort measures such as abdominal support.