External cephalic version, with or without tocolysis
CPT4 code
Name of the Procedure:
External Cephalic Version (ECV): Also known as "version" or "to turn the baby."
Summary
External cephalic version (ECV) is a manual medical procedure where a healthcare provider tries to turn a fetus from a breech (bottom first) or side-lying position into a head-down (vertex) position to facilitate a safer vaginal delivery.
Purpose
ECV is performed to correct abnormal fetal positioning to increase the chances of a successful vaginal birth and reduce the need for a cesarean section (C-section).
Indications
- Breech presentation (when the baby is bottom or feet first) after 36 weeks of gestation.
- Transverse lie (when the baby is lying sideways) near term.
- Suitable maternal and fetal health with no contraindications for vaginal delivery.
Preparation
- Patient may need to fast for a few hours before the procedure.
- Pre-procedure ultrasound to confirm baby's position and monitor amniotic fluid levels.
- Non-stress test to ensure fetal well-being.
- Tocolysis may be administered to relax the uterus and facilitate the turning.
Procedure Description
- The patient lies flat on a hospital bed.
- Ultrasound is used to locate the baby's position and check for complications.
- The healthcare provider places their hands on the patient's abdomen and gently applies pressure to move the baby into a head-down position.
- Continuous fetal monitoring throughout the procedure.
- The procedure may be assisted by medication to relax the uterine muscles, known as tocolysis.
- If successful, the baby's head will be oriented downwards ready for vaginal delivery.
Duration
The entire procedure typically lasts between 30 minutes to 1 hour.
Setting
Performed in a hospital setting, often in a labor and delivery suite or a specialized maternity unit.
Personnel
- Obstetrician or trained healthcare provider
- Nurses or midwives
- Ultrasound technician
- Anesthesiologist (if needed for pain management or sedation)
Risks and Complications
- Discomfort or pain during the procedure.
- Fetal distress requiring immediate delivery.
- Premature rupture of membranes.
- Placental abruption (rare).
- Need for emergency C-section if complications arise.
Benefits
- Increases the likelihood of vaginal birth.
- Reduces the risks and recovery time associated with a C-section.
- Immediate results, as fetal positioning will be known right after the procedure.
Recovery
- Monitoring of fetal heart rate for a few hours post-procedure.
- Possible mild cramping or discomfort after the ECV.
- Observation for any signs of labor or complications.
- Follow-up appointments to ensure the baby remains in the corrected position.
Alternatives
Planned Cesarean Section: Directly scheduling a C-section for breech presentation.
- Pros: Generally safe and avoids the risks associated with ECV.
- Cons: Longer recovery time and higher surgical risks.
Trial of Breech Vaginal Delivery: Attempting vaginal delivery without turning the baby.
- Pros: Avoids the discomfort of ECV.
- Cons: Higher risk of complications for both mother and baby compared to vertex delivery.
Patient Experience
- Patients may experience discomfort and pressure during the procedure.
- Post-procedure: Mild cramping and abdominal discomfort.
- Pain management: Over-the-counter pain relief or prescribed medication if necessary.
- Emotional support from healthcare team and family can help alleviate anxiety and discomfort.