The external cephalic version (VCE) is a technique that aims to manually turn over the baby that is misplaced in order to avoid a breech or a cesarean delivery.
Despite being the best alternative, recommended by the World Health Organization for its effectiveness and safety, to avoid the risk of infant and maternal morbinatality associated with both vaginal delivery as a caesarean section in a podic position, it is still a rare practice some countries. There are many mothers who are not offered this alternative when their babies are poorly placed.
What exactly happens in an External Cephalic Version?
In a VCE basically the gynecologist tries to reposition the baby manually from outside. That is, applying pressure on the mother's gut or with a light massage. Tocolytics, medications to prevent uterine contractions, are usually given first to the mother to relax the muscles of the uterus and abdomen and facilitate the maneuver. The success rate of VCE with tocolysis is higher.
Before, after and during the procedure, fetal beats are monitored several times to rule out fetal distress.
In Babies and more Amazing video of an external cephalic version in two minutesWhen my third daughter decided to get on her buttocks in the 39th week of pregnancy and I opted for a VCE, what the doctor did was try to bother her so she would turn around. He placed two fingers behind the baby's neck (outside always) and with them he guided him gently until the head was down. No more was needed.
Are all pregnant women candidates for a VCE?
No, there are certain risk factors that advise against this practice in the following cases:
- Previous placenta
- Existence of uterine scars due to caesarean sections or previous interventions
- Multiple pregnancy
- Previous vaginal bleeding
- Intrauterine growth retardation
- Presence of fetal stress or bradycardia
- Risk of premature delivery
- Oligohydramios
- If the fetus has a full turn of the neck
- Presence of fetal malformations
- Hypertension or maternal obesity
What is the best time to do a VCE?
It is not recommended to practice a VCE before being full term since it is less effective, the baby may turn around again and has more associated risks. Ideally, do not try before the 37th week of pregnancy.
What risks do you have?
Although there is a possibility of vaginal bleeding, placental abruption, rupture of the amniotic sac or of the umbilical cord wrapping around the baby's neck, if practiced under the right conditions, WHO considers that there is no risk real neither for the fetus nor for the mother. Not that fetal losses associated with this maneuver have been recorded in 1000 VCE series.
In the hospital where they did it to me for example, in the ten years they had been doing it they had not had any case of death or fetal injury related to the VCE.
Is it painful, do we need anesthesia?
VCE is a technique that can be performed on an outpatient basis since it does not require anesthesia of any kind (although spinal anesthesia is used in some centers) or subsequent hospitalization. Depending on how easy or difficult it is to turn the baby, it can be uncomfortable but should not be painful.
In addition, it is not recommended to apply pressure on the uterus for more than five minutes. If after this time the baby has not been able to be turned around, the mother is allowed to rest and tries again a while later.
In my case, the only moment that hurt me was when the baby turned the feet through the placenta. The rest was completely painless and meant very little discomfort. The maneuver itself lasted about two minutes.
A VCE should not be forced too much, if the baby resists spinning or the procedure is extremely uncomfortable or painful for the mother, the doctor will decide to stop and try again a few days later.
Does it always work?
It does not always work. In some cases there is an unknown physical reason for the baby to be in a podic position and not allowed to spin, other babies resist spinning for whatever reason and, the most stubborn, can be put back in a podic position after a successful version . The probability that the procedure will work and the baby will not turn around is 58%.
However, the success rates are very high and the associated risks and costs are very low, so we have nothing to lose by trying.
How many times can it be done?
A VCE can be tried or repeated several times although it is not recommended to do it more than three times in the same pregnancy.
What is needed for a VCE?
Actually, as indicated by the WHO, to practice a VCE it is not necessary more than a stretcher and a stethoscope. However, the ideal conditions for the practice of this maneuver would also require the possibility of performing fetal ultrasound before and after the maneuver to verify the fetal position, a fetal monitor to perform a stress test before and after the procedure and immediate availability. of an operating room in case it causes any complications.
It is also very important that those who perform the technique to avoid complications are expert hands; Not all centers do it.
Really, with the data in hand, the external cephalic version is the best alternative to avoid birth in a podic position and should be offered to all pregnancies whose babies are misplaced.
