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Re: external cephalic versionFrom: Steve & Eryl Raymond (eryl@intekom.co.za)Sat Apr 29 11:38:20 2000
On 27 Apr 2000, at 21:35, Kevin D. Dew MD wrote:
> 1. What gestational age? The WHO Reproductive Health Library states the following in a meta-analysis of trials involving ECV: Conclusions: There is compelling evidence that ECV attempt at term materially reduces the chance of non-cephalic birth and Caesarean section. The randomised trials to date are too small to address the question of the risk of ECV at term, though published uncontrolled series indicate that this is small. In individual cases, the risk of ECV needs to be weighed against the current and future risks of continued breech presentation to mother and fetus. As a result of reading this our policy has been established as follows: 1. Attempt ECV only if breech presentation at 37/40. 2. If unsuccessful then take to a CTG machine and give Ipradol 5mcg. (or another tocolytic) i.v. Within three to five minutes attempt ECV again. 3. Run CTG for five minutes if unsuccessful, 20 minutes if successful. My experience has been that a more than 50 % success rate can be achieved with this procedure. It is true that there are occasions where the procedure results in profound distress in the baby. You need to be ready to do a C/S if the FH doesn't respond to turning on the side and/or oxygen administration. This is excessively rare. Had to do it once in 20 years. Timing of delivery is no different then from your standard cephalic presentation. Steve Raymond
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