Re: external cephalic version
From: Efrain Ramirez (eramirez@icepr.com)
Sun Apr 30 12:28:12 2000
I do not use epidurals. I am comfortable with a 3 out 4 batting
average. I do not longer do breech deliveries - too litigious here.
At Sun, 30 Apr 2000, mark decker wrote:
>
>83-86 more like 90% success - but i do them with epidurals to c-section
>levels and with us guidance at 37 weeks. only one section at that time due
>to fht dropping but that was a late consult at 41 weeks and a section
>without trial.
>
>no injuries to date and i have been in private practice over ten years now
>and using epidurals that time frame. i will try up to five times or so - a
>couple in each direction. some go in 5-7 seconds - yes that is
>correct: and most take 2-3 tries and a few take five - if a couple
>clockwise don't work i try a couple counter clockwise and occasionally i
>will lift the but out of the pelvis by ve and turn it - if that does not go
>i leave them to change on their own or do a vaginal breach later if they
>meet criteria - about 85% or close to it success rate with them as well
>last time i looked - should still be in that range.
>
>mdmd
>
>. At 10:56 PM 4/29/00 -0500, you wrote:
>>On Thu, 27 Apr 2000 21:35:47 -0500, "Kevin D. Dew MD"
>><kdew@bellsouth.net> wrote:
>>
>> >1. What gestational age?
>>
>>36-37 wks
>>
>> >2. How soon afterward do you deliver?
>>
>>When in labor...
>>
>> >3. What do you use to relax the uterus?
>>
>>Terbutaline 0.125 mg IV or 0.25mg IM (I prefer the latter, my partner
>>the former).
>>
>> >Trying to get an idea of what people are doing.
>>
>>I would be interested in whether any significant number of people are
>>using epidurals for versions. I have done both ways and not convinced
>>either by experience or the literature that the extra cost/risk is
>>worth it.
>>
>> >Personally, I've not had a lot of success, perhaps I'm too timid! I section
>> >all my breeches. Only one attending did these in my residency program. I
>> >still picture the dead fetus after the abruption that resulted from
>> >attempted ECV.
>>
>>Would be interested in hearing more about this experience - how many
>>attempts? How "forceful", was u/s used during the procedure?
>>
>>I'm lucky if I get 50% turned. But I will try to turn most - some
>>people with high rates get that way by only offering the procedure to
>>the easy ones.
>>
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