Brech presenation -What measures we can adopt ??External Cephalic Version in 2020:--Threadbare discussions: Young Primi gravida-spont pregancy-at 34 weeks of gestation, Breech presenation with reasonably good pelvis .How many will perform External Cephalic Version?? Why people are not inclining for Extrernal cephalic version?? On principle, I dont recommend to continue such practice in 2020 . But by that I don’t mean that no one should ever perform this simple OPD procedure but the problem lies with selection of women who are going to have this procedure safely without any procedural risk .Selection of such ideal case is a difficult task as there is , to me as many 22 contraindications of this apparently simple OPD procedure. Pre administration of tocolytic has been recommended but I have never used such drug prior to ECV. Reasons against ECV in modern ERA are 1) in cases where it becomes successful there autorotatatoon would have occurred on any way 2) Even if you correct it a fair number will get again converted to breech after few days.3) there can' be procedure related minor abruptio, cord entanglement , unpredictable bradycardia.Fourthly one just cant allow her to go home be it a successful or failed ECV At least one hour waiting period at your OPD / Pvt clinic is warranted which most of us cant afford.Fifthly better not to attempt the procedure before 34 weeks .Sixthly even if breech persists near term and one is not skilled enough to deliver a breech then too CS has become reasonably safe with advent of modern anaesthesia. I shall view the problem of brech presentation in a different perspective .To me it appears that the most difficult art or skill on the part of any accoucheur is not the way one does ECV but to asses the foetopelvic disproprtion and capability of handling the delay in vaginal delivery at three levels like a) breech at perineum b) managing the shoulder delivery of breech pr without any foetal injury / brachial plexus injury ( Lovset) c) tackling the delivery of after coming head of breech.. Top of Form admittedly ,CS will detect some subseptum cong an of uterus .ECV should never be attempted in a) apprehension woman b) suboptimum liquor c) pl. praevia d) Scarred uterus e)pregnancy after long subfertility f) presence of myoma / diagnosed septate uterus g) multiple pregnancy h) FGR i) cornufundal insertion of placenta j) presumable pelvic contraction and K) few medical disorders which can initiate abruptio like PIH,PET, essential HTN, RPL L).. ? Rh negative mother M) mm rupture PROM, N) Need for cs for non foetal indications O,) where tocolytic are contraindicated in case it becomes necessary. P) engaged breech Q,) breech after 36 weeks R) Obesity S) EFE > 4 kg T) military attitude of head I.e. fixed extension of head Incidentally in pre USG era what we used to observe is that if head is at epigastric region then in all probability head was extended to hyper extended and we contain anything by doing ECV as CS is safer .Similarly another tip for juniors is if head is any hypochondriac region then head is possibly flexed attitude and ECV may be tried if there are no contraindications ( 22 as mentioned of ECV).I know most junior members of this Group know that a ballot able head implies incomplete breech whereas a breech which is not freely ballotable at upper quadrant of uterus is possibly having extended legs by its side preventing allotment. In such case easy vaginal delivery is expected. 1 Edit or delete this Like t has been proved time and again , that breech foetus tend to have reduced foetoplacental ratio & reasons are not clear to me even after 50byrsvof practice. Moreover breech foetus have increased HC( source:: Brenner WF , Bruce RD Hendricks CH (1974 ) .The characteristic and perils of breech presentation. Am J Ob & .Gynae 118 , 700 - 712) • Reply • 2h • Edited Write a reply... View 1 more comment Write a comment... TOP POSTS

External Cephalic Version in 2020:--Threadbare discussions: Young Primi gravida-spont pregancy-at 34 weeks of gestation, Breech presenation with reasonably good pelvis .How  many will perform External Cephalic Version??  Why people are not inclining for Extrernal cephalic version?? On principle, I dont recommend to continue such practice in 2020 . But by that I don’t mean that no one should ever perform this simple OPD  procedure but the problem lies with selection of women who are going to have this procedure safely without any procedural risk .Selection of such ideal case  is a difficult task as there is , to me as many 22 contraindications of this apparently simple OPD procedure.  Pre administration of tocolytic has been recommended but I have never used such drug prior to ECV.

Reasons against ECV in modern ERA are 1) in cases where it becomes successful there autorotatatoon would have occurred on any way 2) Even if you correct it a fair number will get again converted to breech after few days.3) there can' be procedure related minor abruptio, cord entanglement , unpredictable bradycardia.Fourthly one just cant allow her to go home be it a successful or failed ECV
At least one hour waiting period at your OPD / Pvt clinic is warranted which most of us cant afford.Fifthly better not to attempt the procedure before 34 weeks .Sixthly even if breech persists near term and one is not skilled enough to deliver a breech then too CS has become reasonably safe with advent of modern anaesthesia. I shall view the problem of brech presentation in a different perspective .To me it appears that the most difficult art or skill on the part of any accoucheur is not the way one does ECV but to asses the foetopelvic disproprtion and capability of handling the delay in vaginal delivery at three levels like a) breech at perineum b) managing the shoulder delivery of breech pr without any foetal injury / brachial plexus injury ( Lovset) c) tackling the delivery of after coming head of breech.. Top of Form

admittedly ,CS will detect some subseptum cong an of uterus .ECV should never be attempted in a) apprehension woman b) suboptimum liquor c) pl. praevia d) Scarred uterus e)pregnancy after long subfertility f) presence of myoma / diagnosed septate uterus g) multiple pregnancy h) FGR i) cornufundal insertion of placenta j) presumable pelvic contraction and K) few medical disorders which can initiate abruptio like PIH,PET, essential HTN, RPL L).. ? Rh negative mother  M) mm rupture PROM, N) Need for cs for non foetal indications O,) where tocolytic are contraindicated in case it becomes necessary. P) engaged breech Q,) breech after 36 weeks R) Obesity S) EFE > 4 kg T) military attitude of head I.e. fixed extension of head
Incidentally in pre USG era what we used to observe is that if head is at epigastric region then in all probability head was extended to hyper extended and we contain anything by doing ECV as CS is safer .Similarly another tip for juniors is if head is any hypochondriac region then head is possibly flexed attitude and ECV may be tried if there are no contraindications ( 22 as mentioned of ECV).I know most junior members of this Group know that a ballot able head implies incomplete breech whereas a breech which is not freely ballotable at upper quadrant of uterus is possibly having extended legs by its side preventing allotment. In such case easy vaginal delivery is expected.

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Edit or delete this

Like t has been proved time and again , that breech foetus tend to have reduced foetoplacental ratio & reasons are not clear to me even after 50byrsvof practice. Moreover breech foetus have increased HC( source:: Brenner WF , Bruce RD Hendricks CH (1974 ) .The characteristic and perils of breech presentation. Am J Ob & .Gynae 118 , 700 - 712)

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