ECV GTG

Question 1

How common is breech?

Answer 1

3-4% term deliveries

Question 2

Success rates ECV multiple and primip

Answer 2

Multi 60%
Primip 40%

Question 3

What % failed ECG will spont turn to cephalic?

Answer 3

8%

Question 4

What % revert to breech after ECV?

Answer 4

3%

Question 5

What factors make ECV more likely to be successful?

Answer 5

Multip
Non-engagement
Tocoloysis
Mat weight <65kg
Posterior placenta
Complete breech position
AFI >10

Question 6

What medication can you give for tocolysis?

Answer 6

250mcg salbutamol in 25ml saline slow IV

250mcg terbutaline

Question 7

What type of drugs is terbutaline?

Answer 7

β₂ adrenergic receptor agonist

Question 8

Who should terbutaline not be given to?

Answer 8

• Placental abruption
• APH
• Eclampsia
• Hx cardiac disease
• IUD
• Intrauterine infection
• Risk MI

Not effective if taking beta-blockers

Question 9

When should ECV be offered?

Answer 9

From 37 weeks, can be considered at 36 weeks for primips.

Question 10

Contraindications to ECV:

Answer 10

Placental abruption, severe PET, abnormal doppler or CTG, absolute reason for CS already exsists (Placenta praevia), multiple pregnancy (except after delivery of first baby), rhesus isoimmunisation, current or recent (< 1 week) vaginal bleeding, abnormal CTG, rupture of membranes, mother decline

Caution: Oligo or HTN

Question 11

Can it be offered to women with previous CS?

Answer 11

Women should be informed that ECV after 1 CS appears to have no greater risk than an unscarred uterus

Question 12

Risk of EMCS within 24hrs of ECV

Answer 12

0.5%

Normally due to abnormal CTG or PVB

Question 13

What are the maximum number of attempts for ECV?

Answer 13

4 attempts, max 10 mins overall

Question 14

If patient rhesus negative?

Answer 14

Give anti-D within 72 hours 500IU and kleiheurs

Question 15

How sensitive is abdominal examination for breech presentation?

Answer 15

70%

Question 16

What is the recurrence rates of breech?

Answer 16

10% - should have USS at 36 weeks

Question 17

If successful ECV, any impacts on labour outcomes?

Answer 17

Higher rates of CS and instrumental

Question 18

Can ECV be offered for unstable lie?

Answer 18

Yes but IOL immediately after

Question 19

What is the rates of perinatal mortality in vaginal breech and ELCS for breech?

Answer 19

Vaginal breech: 2/1000
(Normal birth 1/1000)
ELCS 0.5/1000

Question 20

EMCS is need in what % vaginal breech deliveries?

Answer 20

40%

Question 21

What risk factors are more likely to make vaginal breech less likely?

Answer 21

Hyperextended neck on ultrasound
High estimated fetal weight (more than 3.8 kg)
Low estimated weight (less than tenth centile)
Footling presentation
Evidence of antenatal fetal compromise.

If identified offer CS

Question 22

In what situation can vaginal breech be considered for augmentation?

Answer 22

IOL not normally recommended

Can be considered Regional anaesthesia and slow contraction