Update on external cephalic version performed at term.

External cephalic version under tocolysis at term was investigated during a prospective study at the Los Angeles County/University of Southern California Medical Center from October 1, 1979 to March 16, 1983. Two hundred twelve patients were considered for attempted version. Forty-one patients were excluded, and 23 patients as previously reported were randomized to the control group. The procedure was successful in 73% (108 of 148). Of the 102 successful versions observed until delivery (six lost to follow-up), 93% (95 of 102) presented in labor with a vertex presentation; seven fetuses reverted to abnormal lies. The cesarean section rate in the success group with a vertex presentation was 24% (23 of 95).

The role of external version in the intrapartum management of the transverse lie presentation.

External version under tocolysis was applied and studied prospectively as an alternative to routine cesarean delivery in the laboring patient with a transverse lie presentation. After sonographic confirmation and signing of informed consent, 12 patients with a transverse lie presentation and intact membranes agreed to participate in the current investigation. For these 12 patients, 10 (83%) presentations were successfully converted to a longitudinal lie (nine cephalic, one breech) and two (17%) remained transverse. Of the 10 patients with successful conversions, six (60%) delivered vaginally while four required cesarean delivery. In two (20%) patients external version was unsuccessful and both patients were delivered by cesarean. With the exception of one infant with congenital anomalies, neonatal outcome was excellent in the study population. Overall, the use of external version in the laboring patient with a transverse lie presentation was associated with a 50% reduction in the cesarean section rate. While these results are encouraging, further experience is still needed to more clearly define the maternal and fetal risks associated with this procedure.

Observations of fetal heart rate characteristics related to external cephalic version and tocolysis.

External cephalic version performed in conjunction with tocolysis in the term breech presentation has been found to decrease the number of breech presentations at delivery and thus reduce the number of cesarean sections for breech presentation. However, information regarding the fetal heart rate (FHR) patterns associated with version is limited. In an attempt to broaden our understanding of the FHR changes that occur in association with version, the FHR tracings of 141 patients who had undergone version were analyzed. Approximately 39% of the fetuses exhibited changes in FHR characteristics during and/or after attempted version. These FHR changes were primarily manifested as bradycardias and/or decelerations. However, some of the fetuses (less than 5%) demonstrated a tachycardia or sine wave pattern. All of these FHR changes were transient and bore no apparent relationship to the subsequent outcome of the fetus. In addition to these FHR alterations, the incidence of diminished FHR variability (less than or equal to 5 bpm) was significantly higher after version than before version (p less than 0.01). The decline in FHR variability lasted 15 +/- 12 minutes. While this decline in variability appeared to be related to the success or failure of the version, the decreased variability observed after version was found to be unrelated to the tocolytic agent used and to the subsequent fetal outcome. In summary, alterations in FHR activity were frequent during the version process. All were transient and most responded to cessation of manipulation. Subsequent fetal outcome was apparently unrelated to the observed FHR alterations. Nonetheless, continuous fetal monitoring during and after the version is recommended.