Re: external cephalic version
From: Efrain Ramirez (eramirez@icepr.com)
Sun Apr 30 12:05:51 2000
It's good for me anyhow :-) - besides lawyers, patient and relatives.
>At Sat, 29 Apr 2000, Jim Connerth wrote:
>
>Ahh-good question! Has it been established that maternal oxygen is beneficial
>to fetal unit?
>
>Ronnie Martinez Brignardello wrote:
>
>> why oxygen?
>>
>> ronnie
>>
>> Steve & Eryl Raymond wrote:
>>
>> > On 27 Apr 2000, at 21:35, Kevin D. Dew MD wrote:
>> >
>> > > 1. What gestational age?
>> > > 2. How soon afterward do you deliver?
>> > > 3. What do you use to relax the uterus?
>> > >
>> > > Trying to get an idea of what people are doing.
>> > >
>> > 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
--
"The things you learn after you know everything are the important ones"
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