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

1. The patient lies flat on a hospital bed.
2. Ultrasound is used to locate the baby's position and check for complications.
3. The healthcare provider places their hands on the patient's abdomen and gently applies pressure to move the baby into a head-down position.
4. Continuous fetal monitoring throughout the procedure.
5. The procedure may be assisted by medication to relax the uterine muscles, known as tocolysis.
6. 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.