External Cephalic Version (ECV) Overview
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Questions and Answers

What is a potential risk factor for dystocia after a successful external cephalic version (ECV)?

  • Large maternal pelvis
  • Nulliparity
  • Engaged presenting part
  • Unengaged presenting part (correct)

How do the rates of cesarean births compare between fetuses who achieved cephalic presentation through ECV and those who did so spontaneously?

  • Lower for ECV
  • Higher for spontaneous version
  • Higher for ECV
  • Similar for both (correct)

Which group is more likely to have a successful vaginal birth after a successful ECV?

  • Nulliparous patients
  • Patients with prior cesarean births
  • Multiparous patients (correct)
  • Patients with a small pelvis

What is a significant consideration when evaluating the cost-effectiveness of ECV versus scheduled cesarean birth?

<p>Probability of successful ECV greater than 32% (B)</p> Signup and view all the answers

Which of the following is NOT a risk associated with ECV?

<p>Neonatal infection (D)</p> Signup and view all the answers

In the case of persistent breech presentation, which complication is potential?

<p>Cord prolapse (A)</p> Signup and view all the answers

What maternal risk is associated with planned cesarean birth?

<p>Increased surgical site infection (B)</p> Signup and view all the answers

Which fetal/neonatal risk is associated with the procedure of cesarean birth?

<p>Transient tachypnea of the newborn (A)</p> Signup and view all the answers

What was the increase in the success rate of external cephalic version (ECV) after implementing a standardized protocol?

<p>From 47 percent to 61 percent (C)</p> Signup and view all the answers

What does a forebag measurement greater than 1 cm indicate regarding ECV?

<p>Higher likelihood of successful ECV (C)</p> Signup and view all the answers

In a study of 180,000 participants with breech fetuses, what was the cesarean birth rate for those who attempted ECV?

<p>43 percent (D)</p> Signup and view all the answers

What was the cesarean birth rate after successful ECV in another study that included 2614 ECV attempts?

<p>55 percent (C)</p> Signup and view all the answers

What was the relative risk of cesarean birth for those with a successful ECV compared to cephalic-presenting fetuses?

<p>2.19 (B)</p> Signup and view all the answers

Which factor contributes to varying cesarean birth rates across different countries regarding ECV outcomes?

<p>Local practices regarding vaginal breech birth (B)</p> Signup and view all the answers

What was the cesarean birth rate for those who experienced unsuccessful ECV attempts based on the same study?

<p>93 percent (A)</p> Signup and view all the answers

How does the cesarean birth rate for patients with successful ECV compare to the general obstetric population?

<p>It remains higher than the general population (B)</p> Signup and view all the answers

What was the pooled complication rate reported for external cephalic version (ECV)?

<p>6.1 percent (C)</p> Signup and view all the answers

What is the pooled risk of stillbirth associated with ECV attempts?

<p>0.19 percent (A)</p> Signup and view all the answers

What was the risk of emergency cesarean birth calculated from ECV attempts?

<p>1 in 286 (C)</p> Signup and view all the answers

How many perinatal deaths occurred in the attempted ECV group in the systematic review mentioned?

<p>2 out of 644 infants (D)</p> Signup and view all the answers

What was the corrected perinatal mortality rate in the cohort of ECV attempts?

<p>0.12 percent (B)</p> Signup and view all the answers

What complication had a pooled risk of 0.18 percent in ECV attempts?

<p>Abruption (C)</p> Signup and view all the answers

Which factor showed no definite correlation to the risk of complications in ECV?

<p>Success of the ECV (B)</p> Signup and view all the answers

What percentage of the analyzed complications included abnormal fetal heart rate changes?

<p>Part of the overall 6.1 percent (A)</p> Signup and view all the answers

Flashcards

External Cephalic Version (ECV)

A technique to turn a baby from a breech (buttocks-first) position to a head-first position.

Success Rate of ECV

The percentage of ECV procedures that were successful in repositioning the baby.

Forebag Measurement

Measuring the distance from the cervix to the baby's presenting part.

ECV and Cesarean Birth Rate

Patients with successful ECV face a higher risk of cesarean delivery compared to normal pregnancies.

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Variability in Cesarean Rates

Cesarean birth rates vary based on local practices allowing vaginal breech birth.

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Breech Presentation

A baby positioning in which the buttocks or feet are positioned to emerge first during delivery.

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Cephalic Presentation

A baby positioning with the head presented first.

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Success in ECV

ECV is associated with lower risk of cesarean delivery than no ECV attempt.

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Dystocia after ECV

Difficult labor after a successful ECV.

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Parity and ECV

Multiparous (more than one pregnancy) patients have a higher chance of vaginal birth after successful ECV.

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ECV and Cesarean Section

Rates of C-section are similar for babies in cephalic position after ECV compared to spontaneous cephalic presentations.

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ECV Cost-Effectiveness

ECV can be more cost-effective than a scheduled C-section for breech presentation.

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ECV Risks

Rare but potential risks include stillbirth, placental abruption, and emergency C-section.

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Persistent Breech Risks

Risks of persistent breech presentation include cord prolapse and potentially a C-section.

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Planned Cesarean Risks

Planned C-sections have risks, like infections, injury, or bleeding for the mother, and possible neonatal complications.

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ECV complication rate

6.1% (95% CI 4.7-7.8) overall, including abnormal fetal heart rate changes, fetomaternal transfusion, vaginal bleeding, and risks like emergency cesarean birth, etc.

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Stillbirth risk (ECV)

0.19% (95% CI 0.12-0.27) - 1 in 5000 attempts.

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Abruption risk (ECV)

0.18% (95% CI 0.12-0.26) - 1 in 1200 attempts.

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Emergency Cesarean birth risk (ECV)

0.35% (95% CI 0.26-0.47) - 1 in 286 attempts

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ECV success correlation

A correlation between ECV success and complication risk was not observed.

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Perinatal mortality (ECV)

0.12% in 2614 ECV attempts.

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Child-related risks

Increased risk for some childhood medical illnesses (asthma, laryngitis, etc) and reduced brain maturation.

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Observation studies & trials

Studies that followed large numbers of ECV patient's health and medical outcomes.

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Study Notes

External Cephalic Version (ECV)

  • ECV is a procedure to rotate a fetus from a non-cephalic to a cephalic presentation.
  • It's typically performed electively in non-laboring patients near term to increase the chances of vaginal birth.
  • Success is influenced by maternal and fetal factors, including factors such as placenta position and amniotic fluid levels

Outcomes

  • Success rates vary widely (22% to 76%).
  • A meta-analysis of 84 studies (13,000 attempts) showed a pooled success rate of 58%.
  • Reversion to breech presentation can happen in a small percentage of successful cases( 2.2% in one study ).
  • Some patients have spontaneous version to cephalic presentation after an unsuccessful ECV. (4.3% in one study).
  • ECV affects the rate of cesarean birth, as more fetuses remain in cephalic position at birth.

Factors that impede success

  • Anterior, lateral, or cornual placenta position
  • Low amniotic fluid volume
  • Descent of breech into pelvis
  • Female gender
  • Non-palpable fetal head
  • Firm maternal abdominal muscles
  • Frank breech presentation
  • Low birth weight
  • Nulliparity (compared with parous patients)
  • Obesity (especially high BMI)

Factors that enhance success

  • Amniotic fluid index greater than 10 cm
  • Complete breech position
  • Non-longitudinal lie (oblique or transverse)

Unlikely and Controversial factors

  • Larger fetuses (no evidence to avoid ECV if trial of labor planned)
  • Nuchal cord (limited data regarding ECV and nuchal cord)
  • HIV-positive patients (there is a theoretical low risk)
  • Prior low transverse cesarean (not a contraindication, but individualized decision needed)
  • Unengaged presenting part (forebag >1 cm is highly predictive of success in some research)

Timing

  • Typically performed after 36 0/7 weeks gestation.
  • Some clinicians may offer ECV earlier (34-35 weeks), but benefits must be weighed against risk of preterm birth.
  • ECV can be performed later (39 weeks) if the fetus is in a nonlongitudinal lie.

Alternatives to ECV

  • Expectant management.
  • Postural maneuvers
  • Moxibustion and acupuncture.

Risks Associated with ECV

  • Stillbirth
  • Abruption
  • Emergency cesarean birth

Procedure

  • Ultrasound examination before the procedure to evaluate fetal position and confirm gestational age.
  • Evaluation of maternal well-being.
  • ECV technique involves manipulating the fetus.
  • Tocolysis may be used to relax the uterus
  • Fetal heart rate monitoring is essential.

Postprocedure

  • Fetal well-being monitoring (e.g., cardiac monitoring) is essential, including a reactive fetal heart rate response.
  • Anti-D immune globulin (if needed)
  • No elective induction
  • Review of management strategies for unsuccessful ECV attempts and for patients with a persistent breech presentation after ECV

Management after an Unsuccessful ECV

  • Reattempt ECV after 2 days if the first attempt was unsuccessful.
  • Some patients have successful spontaneous version subsequent to failed ECV attempts.
  • For persistent breech presentation after ECV, there are additional management guidelines.

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External Cephalic Version PDF

Description

This quiz covers the process and outcomes of External Cephalic Version (ECV), a procedure aimed at rotating a non-cephalic fetus to a cephalic presentation. It discusses success rates, influencing factors, and the implications of ECV on delivery outcomes. Test your knowledge on this vital obstetrical procedure.

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