Breech,+Transversie+Lie+and+Version

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Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours. Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.

**Delivery Planning for Breech and Fetal Malpresentations**
External cephalic version (ECV) is a procedure used to turn a fetus from breech or transverse position into a vertex position before labor begins in preparation for vaginal birth. Contra Costa Regional Medical Center Perinatal Unit offers external cephalic fetal version and is committed to making this option safe for an expectant mother who has a fetal malpresentation, and desires a vaginal delivery. The success rate of version is about 60%. Version is performed only on the Perinatal Unit so that in the very rare event of concern about fetal wellbeing we can intervene appropriately. Expectant mothers with a fetal malpresentation also have the option of an elective cesarean section normally scheduled sometime after 39w0d. __**Expectations of Prenatal Care**__
 * Review obstetric history for accuracy. Verify fetal position post 36 weeks EGA in all patients using ultrasound liberally to verify when clinical exam is uncertain. Antepartum testing appointment for position check ultrasound is available—formal ultrasound is unnecessary. If baby appears oblique recommend having patient empty her bladder and rescan to verify moves to vertex.


 * If breech or transverse lie, assess whether vaginal delivery is both appropriate and desired by the expectant mother. If so, offer external fetal cephalic version. Women should NOT undergo a fetal version if they have a history of placental abruption, placental abruption is suspected, there is a diagnosis of severe pre-ecclampsia, there are signs of fetal distress or oligohydramnios. Prior cesarean is not a contraindication to version, if she is otherwise a candidate for a VBAC birth.


 * Schedule your patient for ECV by calling the Perinatal Unit at 925-370-5608. She should be at least 37w0d. The success rate declines with more advanced pregnancies so close to 37w0d is most ideal. If ECV is unsuccessful we will schedule an elective cesarean after 39w0d or a reattempt at another time, per patient preference. Occasionally a baby becomes spontaneously vertex post an unsuccessful ECV—if this occurs, the cesarean will be cancelled.

__**Instructions for Fetal Version**__ Advise the patient that:
 * The procedure is uncomfortable and not always successful.


 * She may have an IV placed.


 * Occasionally a successfully turned baby can turn back to the malpresentation.


 * Very, very rarely there can be injury to the fetus, placenta or uterus and that we are prepared to deliver by cesarean immediately if there is concern.


 * The baby will be monitored before and after the procedure.


 * She should expect to be on labor and delivery for about 3 hours. She may be given a medication to relax the uterus (terbutaline)


 * Rhogam will be given if she is Rh negative


 * If she is > 39 weeks EGA, she should arrive NPO after midnight or for at least 6 hours to facilitate a same day cesarean if the version is unsuccessful


 * If she is 37-39 weeks, she should have only clear liquids for 6 hours before arrival

Feel free to consult with the OB on call or a prenatal provider at your site for more information or assistance.