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Malpresentation And Malposition
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Alexis C. Gimovsky, Andrea Dall’Asta, Giovanni Morganelli, Tullio Ghi
External cephalic version (ECV) is a safe and effective intervention for malpresentation. Urgent cesarean delivery (CD) for nonreassuring fetal heart rate tracing (NRFHT) and placental abruption occur in <0.5% of ECVs.
Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
External cephalic version delivery is safe if viral load is suppressed. Vaginal delivery is recommended if viral load is suppressed at 36 weeks. Vaginal birth after caesarean section is safe. Instrumental delivery is generally avoided, but data seem to say it is safe. Elective caesarean section is recommended for women on monotherapy regardless of viral load (except elite controllers) and viral load >400 copies/ml and should be done between 38 and 39 weeks.
Breech presentation
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, Martin L. Gimovsky
There is a place for external cephalic version even in early labor. Depending on the stage of labor at which the patient is admitted and the time when breech presentation is diagnosed, immediate ß-mimetic tocolysis is often successful in permitting manipulations. However, after rupture of the membranes and the onset of true labor, any attempt at version becomes both difficult and inherently dangerous, owing to the descent of the presenting part and the potential risk of cord prolapse.
Analysing the likelihood of caesarean birth after implementation of the two-childbirth policy in China, using the Ten Group Classification System
Published in Journal of Obstetrics and Gynaecology, 2020
Jie Wen, QinQing Chen, Qiong Luo
As a result of the two-childbirth policy, the number of women in Group 7 (multiparous women with a single breech pregnancy) has grown rapidly and has included a large proportion of multiparous women with previous vaginal births. Those women typically do not prefer having a planned Caesarean section delivery because of the increasing risks the mothers face, in comparison to a vaginal delivery. However, many hospitals and obstetricians have been reluctant to offer assisted breech delivery and breech extraction. In view of this, it is a viable option to convert breech presentation into cephalic presentation by carrying out an ECV. Increasing studies have shown that ECV attempt at term is not associated with increased prenatal morbidity or mortality (Son et al. 2018). Additionally, ECV is accepted and widely attempted in many countries (Mowat and Gardener 2014; Ebner et al. 2016). About 100 women have received an ECV attempt in our hospital since 2018. The success rate of ECV is 51.6% (49 in 95), and even higher in Group 7 (65.8%, 25 in 38) (data not shown in the present study). Despite the fact that this group is relatively small, ECV is an important intervention that may help reduce Caesarean birth rates.
Uterine torsion at term pregnancy associated with a previous pelvic organ prolapse (POP) surgery
Published in Journal of Obstetrics and Gynaecology, 2020
The predisposing factors for uterine torsion are fibroids, pelvic adhesions, ovarian cysts, sudden foetal or maternal movements, external cephalic versions (Havaldar and Ashok 2014; Karavani et al. 2017; Lai et al. 2018). In our case, sacro-hysteropexy procedure could be a reason for uterine torsion due to the change in uterine axis. For performing external cephalic version cases, before and after procedure sonographic evaluation should be done for comparison of changing placenta location or impaired uterine Doppler (Karavani et al. 2017). However, sacrohysteropexy is not yet reported as a reason for uterine torsion in the literature. In our case, unintended extension of posterior lower uterine transverse incision to the Douglas pouch occurred, probably caused by prior POP surgery, so we used lots of haemostatic sutures. Prior sacrohysteropexy in this patient had been done using visceral peritoneum of right side posterior adnexa from the promontorium to the cervix. Therefore, we think that a symmetrical surgical technique could theoretically prevent uterine torsion (Banerjee and Noé 2011; Tahaoglu et al. 2018). All patients should be informed about the complications of conservative POP surgery after pregnancy; including uterine torsion, so POP surgery like sacrohysteropexy and other procedures should preferably be performed when fertility is complete. A recent meta-analysis underlines that recommendations cannot be made about the long-term risks of recurrent prolapse or regarding pregnancy outcomes after uterus-preserving prolapse surgery, because the limits of the trials contained insufficient data on these outcomes (Meriwether et al. 2018). Of course, the long-term outcomes of these procedures are not well studied after pregnancy.
Utilization of epidural volume extension technique for external cephalic version
Published in Baylor University Medical Center Proceedings, 2021
Hanna Hussey, James Damron, Mark F. Powell, Michelle Tubinis
It has been reported that 3% to 4% of singleton pregnancies are breech presentation,1 and the American College of Obstetricians and Gynecologists recommends offering external cephalic version (ECV) to these women. Although the reported success rate of ECV is highly variable, regional anesthesia increases success of the procedure.2 Epidural volume extension (EVE) uses normal saline injected into the epidural space immediately following intrathecal injection of a reduced dose of local anesthetic. This compresses the thecal sac, which can extend the block height to maintain surgical anesthesia.3