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External Cephalic Version

Four randomized, controlled trials of external cephalic version at term have been conducted to evaluate the safety and efficacy of this intervention. All four showed a reduction in the incidence of both intrapartum breech presentation and cesarean delivery rate cephalic version, breech. In the United States, it has been suggested that a program of external cephalic version at term would lower the cesarean delivery rate.

External cephalic version should be performed in accordance with established guidelines:

• Reactive NST should be obtained before and after.

• Ultrasonography should be done before the procedure to confirm presentation, assess amniotic fluid volume.

• Ultrasonography can be used during external cephalic version to monitor both FHR and the progress of the

• External cephalic version should be performed in or very near the labor and delivery suite because immediate delivery.

• The use of tocolysis is favored by most advocates of external cephalic version to facilitate the procedure.

Modern studies confirm a low incidence of perinatal morbidity associated with the procedure; however, uncommon (yet serious) complications of external cephalic version include placental abruption, uterine rupture, fetal-maternal hemorrhage, isoimmunization, fetal distress, and even fetal death. D immune globulin.

Breech presentation should be diagnosed before labor in order for a patient to be extended the option of external cephalic version. If the diagnosis is in doubt at term after performing Leopold's maneuvers and a pelvic examination, ultrasonography.

As clinicians have gained experience and comfort with external cephalic version at term, expanded indications have arisen: intrapartum external cephalic version at term in early labor with intact membranes has had the same success rate as antepartum version. External cephalic version has been shown to avoid cesarean delivery in half of the patients in labor with a transverse lie, an estimated fetal weight of more than 2,000 g, a reactive NST, intact membranes, and normal amniotic fluid volume. In patients with a previous uterine scar, external cephalic version.

A scoring system (Table 21) has been shown to predict success rate. The authors have suggested that women with scores of 4 or less simply may not be candidates for external cephalic version, thus avoiding a costly.

Shoulder Dystocia

Shoulder dystocia is a tree peripartum emergency that is generally unpredictable and associated with serious neonatal morbidity. It is defined as the inability to deliver the fetal shoulders with normal obstetric maneuvers after delivery of the fetal head. Typically, delivery of the fetal head is followed by retraction of the head onto the perineum (turtle sign) during spontaneous or instrumental vaginal delivery. This retraction occurs because the fetal shoulder girdle.