Review for indications. Do not perform this procedure before 37 weeks.
Have the woman lie on her back, and elevate the foot of the bed.
Listen to and note the fetal heart rate. If there are
fetal heart rate abnormalities (less than 100 or more than 180 beats per minute), do not proceed with external version.
Palpate the abdomen to confirm presentation and position of the fetal head, back and hips.
To mobilize the breech, gently lift the lowest part of the fetus from the pelvic inlet by grasping above the pubic bone
(Fig P-5 A).
Bring the head and buttocks of the fetus closer to each other to achieve forward rotation. Rotate the fetus slowly by guiding the head in a forward roll as the buttocks are lifted
(Fig P-5 B–C).
Listen to the fetal heart rate. If an
abnormality is detected:
Have the woman turn on to her left side;
- Give oxygen at 4-6 L per minute by mask or nasal
- Reassess every 15 minutes.
procedure is successful, have the woman remain lying down for 15 minutes. Counsel her to return if bleeding or pain occurs or if she believes the baby has returned to the
procedure is unsuccessful, try again using a backward roll (Fig P-5
procedure is still unsuccessful and fetal heart rate is good, tocolytics may increase the chances of successful version. Give:
- terbutaline 250 mcg IV slowly over 5 minutes;
- OR salbutamol 0.5 mg IV slowly over 5 minutes.
If the procedure is still unsuccessful, attempt version again after 1 week or if the woman presents in early labour with breech or transverse lie.
If they are fetal heart abnormalities:
- Turn the woman onto her left side;
- Reassess the fetal heart rate every 5 minutes;
- If the
fetal heart rate does not stabilize within the next 30 minutes, deliver by
External version of a breech
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