Introduction:
A baby changes positions constantly throughout pregnancy. At the end of the pregnancy, around 36 weeks, most babies will turn into a head-down position that takes place naturally within the uterus as the baby prepares for birth. The head-down position is known as cephalic presentation, and it is the ideal position for a vaginal birth to avoid any complications. After 36 weeks, the doctor will discuss performing an external cephalic version if the baby is in another position, like a breech or transverse. But the external cephalic version will not be ideal for all pregnant women; in such cases, the doctors prefer C-section delivery.
What Is the External Cephalic Version?
An external cephalic version is a procedure performed to turn an unborn baby within the uterus before delivery. While performing this procedure, the healthcare provider places their hands on the pregnant woman's belly and attempts to turn the baby with manual pressure into a cephalic or headfirst position (the baby's head toward the opening of the birth canal).
This procedure is done if the baby is in a breech position. A breech position is when a baby's feet or buttocks are towards the vagina; the head is positioned at the uterus top. It is also performed in a transverse-like position when the baby is positioned horizontally across the uterus. This baby's position complicates the normal vaginal delivery, so it is preferable that the baby is head down before the labor commences.
Who Can Undergo External Cephalic Procedures?
Most pregnant women can undergo ECV; if they are healthy and have a sufficient amount of amniotic fluid in the uterus. The healthcare professionals will check the patient's medical history to determine if ECV is safe. However, in certain pregnant women, ECV is not recommended:
-
The amount of amniotic fluid is very low.
-
The baby is larger than usual.
-
The baby's heart rate is unusually high or low.
-
Irregularly shaped uterus.
-
Pregnant with multiples.
-
Diabetes or high blood pressure.
-
The baby's head is hyperextended (straight instead of bending forward).
-
Complicated pregnancy.
-
Placenta previa.
-
Vaginal bleeding.
-
Requiring C-section due to other health concerns.
-
If the fetus is unwell or not growing well.
How Is This Procedure Performed?
One or two experienced professionals perform the external cephalic version, usually an obstetrician. The approach toward the external cephalic version should be gentle and carried out with a flexible attitude. The obstetrician's brain, nerves, muscles, and fingers should be sensitively elastic. The approach should never be hasty or domineering, which can turn dangerous.
Pregnant women are placed in the supine position. The abdomen is coated with ultrasonic gel to decrease friction and reduce the chances of an over-vigorous manipulation. Initially, the baby presenting position should be determined. Then, a cardiotocograph or CTG will be checked to monitor the baby's well-being 30 minutes before the procedure.
Healthcare professionals may begin with the forward roll or the back flip. However, the direction chosen for the baby's movement does not matter, but most healthcare professionals start with the forward roll. If the head of the baby and the spine are on the same side of the mother's midline, then the backflip may be performed. If the head of the baby and the spine are on different sides of the mother's midline, then the forward roll may have opted. If the initial trial is unsuccessful, a second trial is made in the opposite direction. Studies have proved that changing the fetal spine from the midline to sideways improves the chances of success.
Using an ultrasound probe, monitoring the fetal heart rate during and after attempts of an external cephalic version is essential. The procedure will be discontinued if there is excessive maternal discomfort, evidence of fetal compromise on monitoring, or repeated failure. Suppose the heartbeat of the baby is reduced after a successful version. In that case, it is suggested to return the baby to its previous breech presentation to reduce the tangled cord risk. It usually takes about three hours from beginning to end.
How Successful Is the External Cephalic Version?
The external cephalic version can be successful for a little more than half of the cases. It is more successful if the amount of amniotic fluid is optimal in women who have already had successful ECV and if the baby has not descended into the pelvis. The results of the ECV will be best at 37 weeks because, after 37 weeks, there will be limited space for the baby to move inside the uterus. Before 36 weeks, there are chances for the baby to turn on its own.
What Are the Complications of the External Cephalic Version?
The external cephalic version is successful in most women undergoing normal vaginal births following an ECV. But it is necessary to contact the healthcare professionals if the pregnant woman experiences any of the following:
-
Contractions right after the procedure.
-
If the baby's movement is not felt.
-
Rupture of the membranes.
What Is the Impact of the External Cephalic Version on Labor and Delivery?
If an external cephalic version procedure succeeds, then the labor progresses regularly. ECV procedure usually does not affect the labor's duration or intensity. The risk accompanied by the procedure is the rupture of the membrane, which can initiate labor earlier than usual. The contractions will be more severe in benign labor, whereas in normal labor that occurs without rupture of the membrane, the contractions will happen gradually as labor progresses.
Suppose ECV turned out to be unsuccessful, and the baby remains in the breech position. In that case, a C-section or a vaginal breech delivery can be selected depending on the condition of the patient and the doctor's efficiency. The complications involved with a vaginal breech delivery are that the head of the baby can get stuck in the birth canal or the umbilical cord prolapse, in which the umbilical cord leaves the body before the baby. That can lead to cord compression during delivery. Cord compression can block the oxygen and nutrients supplied to the baby.
Conclusion:
An external cephalic version is a procedure carried out to turn the abnormally positioned baby into a cephalic position. It is preferred in the breech baby. It is performed for women who want to try a vaginal delivery. However, this procedure has many complications and often cannot be performed successfully. So it is necessary to discuss the procedure with the healthcare provider and understand the risks before choosing it.
