Exam (elaborations)
EXTERNAL CEPHALIC VERSION ECV TEST
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EXTERNAL CEPHALIC VERSION ECV TEST...
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Background - ANSWER Breech presentation complicates 3-4% of allterm deliveries and a higher proportion of preterm deliveries. It is more
common where there has been a previous breech presentation.
-ECV at term reduces the incidence of noncephalic presentation at
delivery. Spontaneous version rates for nulliparous women are
approximately 8% after 36 weeks, but less than 5% after unsuccessful
ECV; success rates of ECV are 30-80%. Spontaneous reversion to
breech presentation after successful ECV occurs in less than 5%.
What is the success rate of ECV and what influences it? - ANSWER An
overall success rate of 40% for nulliparous, and 60% for multiparous
women can usually be achieved. The highest success rates are seen
with multiparous, non-white women with a relaxed uterus, where the
breach is not engaged and the head is easily palpable. Success rates
are also higher with increasing liquor volume, but, in practice, very high
liquor volume may be associated with spontaneous reversion. Maternal
weight, placental position, gestation, fetal size and position of the legs
make less difference and are probably not independent of other factors.
-The use of tocolysis with beta-sympathomimetics may be offered to
women undergoing ECV as it has been shown to increase the success
rate.The use of tocolysis should be considered where an initial attempt
at ECV without tocolysis has failed. A simple protocol is to offer a slow
intravenous or subcutaneous bolus of salbutamol or terbutaline either
routinely or if an initial ECV attempt has failed. Women should be
advised of the adverse effects of tocolysis with beta-2 agonists.
-Where ECV fails the possibility of a further attempt should be
discussed.
{A later, second attempt, particularly with a second operator or where
the back has been in the midline, may lead to a small increase in overall
success rates but tocolysis markedly increases the success rate at a
second attempt if it has not been used first. Other methods employed to
increase success rates include the application of noise to the abdomen
(fetal acoustic stimulation) where the back is in the midline, and regional
analgesia, including after a failed initial attempt. For the latter, an
increase in success rate is evident with epidural but not spinal analgesia.
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