Seven months, eight months, the countdown is almost over. One of the most exciting events in your life is about to happen, a new addition to the family. Your obstetric visits are now once a week, but this week the doctor asks you to come back a second time because the baby is in a breech position. Many physicians try to avoid cesarean section and delivering a breech baby, due to the many complications. One option to avoid these sometimes-fatal procedures is an External Cephalic Version (ECV).
An ECV is a procedure that your obstetrician does, to attempt to turn the baby to a head down or vertex position. First the expecting mother is given a non-stress test to be sure that the fetus is stable enough to undergo the procedure. A liberal amount of ultrasonic gel is placed on the abdomen of the mother then the head is gently guided by the trained professional to the vertex position. During the procedure the mother is hooked up to a fetal monitor to determine immediately any fetal distress. The heart rate, movements and when applicable any contractions are monitored carefully. If any complications are to arise the procedure is generally done in a facility which is ready for an emergency cesarean section.
Breech presentation at full term only occurs in about 4% of pregnancies. The physicians do not recommend the mother schedule the ECV until her 37th week; they recommend this so that there is no opportunity for spontaneous reversion. Spontaneous reversion is when the baby returns to the breech position after an attempted ECV; the rate for this is 16%. The success rate of an ECV is about 69.5% this includes a range of 48% to 77%.
Some of the adverse affects though few and far apart are umbilical cord entanglement, abruptio placenta, preterm labor, premature rupture of the membranes, and maternal discomfort. The mothers who are candidates for an ECV should; be no less than 36 weeks, frank or complete breech presentation, flexed fetal head, no major fetal anomalies and no placenta previa on ultrasound. Due to the success rate of the ECV the amount of cesarean sections throughout the United States has drastically dropped. In 1990 the average of cesarean sections was 914,000, in 1995 the average was 807,000, and in 1996 the average was 797,000.
With all the precautions, outlines and knowledge about this procedure the outcome is ideal for the new arrival to the family and the mother to be. This procedure has also drastically cut the amount of cesarean sections over the last ten years. The maternal mortality rate and fetal mortality rate have also decreased. A procedure which decreases the specific factors in which the ECV does is ideal for those expecting parents who are given the news that there baby is breech.