All women eligible with breech presentation that are close to the end of pregnancy should be offered version cephalic external, to reduce the number of caesareans, according to the American College of Obstetricians and Gynecologists (ACOG).
The version cephalic external consists in applying a pressure on the abdomen breast to turn the fetus from breech presentation to cephalic, by increasing così the chanceà to have a spontaneous delivery.
The bulletin of February, developed by the Committee of ACOG , collects evidence for a more recent version of the cephalic and external recommendations for its use, by replacing the recommendations of the February 2000.
“The version cephalic external”, writes the committee, is one possible technique that, in an unselected population, has a few risks both for the mother and for the fetus. If successful, the version cephalic external provides a clear benefit to the woman, giving her a chanceà to a spontaneous delivery of the vertex.
The interest for this technique is increased in the light of the movement in medicine to decrease the caesarean sections, which often seem to be the only option for breech presentation. Previous studies have shown that women who have had a successful version cephalic external the number of caesarean sections è più bottom than those who have not been able to get it.
Six points in the index
The recommendation level of the ACOG (just on the evidence of consistent, good qualityà) said that “all women close to term with a fetus in breech should receive the offer of the version external cephalic, if there are no contraindications”.
Recommendation level B (based on limited evidence or not significant) consist of three points:
- The fetal presentation should be assessed at 36 weeks of pregnancy, to allow for the execution of the version cephalic external. If the version that is spontaneous is going to happen, the more it will beà easy to manoeuvre. Also in this period, the risk that it runs again is; più low that in the time before the pregnancy.
- Have had a previous caesarean section is not; related to a lower rate of success;however do not è clear that this increases the risk of uterine rupture.
- evidence to support the use of beta-agonists intravenously to increase.
The two recommendations are based primarily on meetings and on the opinions of the experts:
- The doctors should check for the fetal well-being and the possible presence of contractions with a non-stress test or a biophysical profile of the fetus before and after version cephalic to external operating.
- The procedure should only be performed in environments in which you can perform promptly a caesarean section.
If after the maneuver, there is still a breech presentation, the best way to carry out the delivery depends on the skills of the operators.
Then a figment a single term in a breech presentation può be reasonable in some cases, with a complete counseling of the patient and his consent, concludes the bulletin.
Source: Obstet Gynecol. 2016;127:412-413
February 9, 2016
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