External Cephalic Version

ExitCare ImageExternal cephalic version is turning a baby that is presenting their buttocks first (breech) or is lying sideways in the uterus (transverse) to a head-first position. This makes the labor and delivery faster, safer for the mother and baby, and lessens the chance for a Cesarean section. It should not be tried until the pregnancy is 36 weeks along or longer.

BEFORE THE PROCEDURE

  • Do not take aspirin.

  • Do not eat for 4 hours before the procedure.

  • Tell your caregiver if you have a cold, fever or an infection.

  • Tell your caregiver if you are having contractions.

  • Tell your caregiver if you are leaking or had a gush of fluid from your vagina.

  • Tell your caregiver if you have any vaginal bleeding or abnormal discharge.

  • If you are being admitted the same day, arrive at the hospital at least one hour before the procedure to sign any necessary documents and to get prepared for the procedure.

  • Tell your caregiver if you had any problems with anesthetics in the past.

  • Tell your caregiver if you are taking any medications that your caregiver does not know about. This includes over-the-counter and prescription drugs, herbs, eye drops and creams.

PROCEDURE

  • First, an ultrasound is done to make sure the baby is breech or transverse.

  • A non-stress test or biophysical profile is done on the baby before the ECV. This is done to make sure it is safe for the baby to have the ECV. It may also be done after the procedure to make sure the baby is OK.

  • ECV is done in the delivery/surgical room with an anesthesiologist present. There should be a setup for an emergency Cesarean section with a full nursing and nursery staff available and ready.

  • The patient may be given a medication to relax the uterine muscles. An epidural may be given for any discomfort. It is helpful for the success of the ECV.

  • An electronic fetal monitor is placed on the uterus during the procedure to make sure the baby is OK.

  • If the mother is Rh negative, Rho-gam will be given to her to prevent Rh problems for future pregnancies.

  • The mother is followed closely for 2 to 3 hours after the procedure to make sure no problems develop.

BENEFITS OF ECV

  • Easier and safer labor and delivery for the mother and baby.

  • Lower incidence of Cesarean section.

  • Lower costs with a vaginal delivery.

RISKS OF ECV

  • The placenta pulls away from the wall of the uterus before delivery (abruption of the placenta).

  • Rupture of the uterus, especially in patients with a previous Cesarean section.

  • Fetal distress.

  • Early (premature) labor.

  • Premature rupture of the membranes.

  • The baby will return to the breech or transverse lie position.

  • Death of the fetus can happen, but is very rare.

ECV SHOULD BE STOPPED IF:

  • The fetal heart tones drop.

  • The mother is having a lot of pain.

  • You cannot turn the baby after several attempts.

ECV SHOULD NOT BE DONE IF:

  • The non-stress test or biophysical profile is abnormal.

  • There is vaginal bleeding.

  • An abnormal shaped uterus is present.

  • There is heart disease or uncontrolled high blood pressure in the mother.

  • There are twins or more.

  • The placenta covers the opening of the cervix (placenta previa).

  • You had a previous cesarean section with a classical incision or major surgery of the uterus.

  • There is not enough amniotic fluid in the sac (oligohydramnios).

  • The baby is too small for the pregnancy or has not developed normally (anomaly).

  • Your membranes have ruptured.

HOME CARE INSTRUCTIONS

  • Have someone take you home after the procedure.

  • Rest at home for several hours.

  • Have someone stay with you for a few hours after you get home.

  • After ECV, continue with your prenatal visits as directed.

  • Continue your regular diet, rest and activities.

  • Do not do any strenuous activities for a couple of days.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop vaginal bleeding.

  • You have fluid coming out of your vagina (bag of water may have broken).

  • You develop uterine contractions.

  • You do not feel the baby move or there is less movement of the baby.

  • You develop abdominal pain.

  • You develop an oral temperature of 102° F (38.9° C) or higher.