External cephalic version under tocolysis.

Abstract

We currently consider the external version of the fetus from a breech to a vertex presentation near term the best solution to the disadvantages of a breech delivery for mother and child. Version at such a late time in gestation is only possible with the aid of the tocolytic relaxation of the uterus as recommended by us. This method offers two important advantages over the conventional method of external version, the performance of which after the 34th week of gestation has been discouraged because of the poor chance for success: 1. Because of the relatively decreased intrauterine space during the last month of pregnancy the fetus will revert less readily to a breech. 2. In the event of a complication during external version the immediate operative delivery of the mature infant near term is possible. After the presentation of the fetus has been diagnosed by ultrasound the mother is given 20-50 micrograms Fenoterol (Partusisten) intravenously simultaneously with an inhalation analgesia. The version itself is effected by positioning the hands of the operator against the fetal forehead and by turning the infant as in a backwards roll. If this fails, the dose of the tocolytic agent may be increased. In cases with extended legs the chances for success appear to be decreased. The completed version should be confirmed with an ultrasound examination and the undisturbed status of the fetus should be documented with a cardiotocogram immediately after the version. The following results were achieved: The external version was successful in 43 of 57 pregnant women (75%). If the material is selected more critically, over 80% of the attempted versions should be successful. We have now delivered 40 infants as vertex presentations after a previously diagnosed breech presentation. The frequency of breech deliveries in our hospital has decreased by 2.6% from 5.4% to 2.9% since the introduction of version. The decrease is statistically significant. Convincing evidence that version has decreased fetal risk from breech delivery is found in a comparison of the newborn status. The decrease in the percentages of clinically depressed and acidotic newborns is also statistically significant. The failure rate does not appear to increase with increasing gestational age. There is no correlation between parity and failure or between maternal age and failure. So far we have seen no serious complications. In 5 of 24 cardiotocograms recorded a transient fetal bradycardia occurred immediately after the version which disappeared after a few minutes of maternal lateral position.