External cephalic version - Revision history

Tony.Wang at 14:37, 24 May 2023

2023-05-24T14:37:42Z

@@ Line 106: / Line 106: @@
 === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
 There is imminent risk of fetal distress with the ECV, thus there should always be an available operating room for emergent [[Cesarean section]].
 == References ==
 [[Category:Surgical procedures]]

Tony.Wang at 16:33, 27 October 2022

2022-10-27T16:33:48Z

← Older revision		Revision as of 09:33, 27 October 2022
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	** CSE can be used to titrate up to effect		** CSE can be used to titrate up to effect
	* Epidural dose: lidocaine 2% ~10 mL		* Epidural dose: lidocaine 2% ~10 mL
			*Reaching a T6 level is generally adequate

	== Intraoperative management ==		== Intraoperative management ==

Tony.Wang at 16:31, 27 October 2022

2022-10-27T16:31:02Z

← Older revision		Revision as of 09:31, 27 October 2022
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	\| lines_access = 1 PIV		\| lines_access = 1 PIV
	\| monitors = Standard OB bedside monitors (EKG, pulse ox, NIBP, fetal HR monitoring)		\| monitors = Standard OB bedside monitors (EKG, pulse ox, NIBP, fetal HR monitoring)
	\| considerations_preoperative =		\| considerations_preoperative = Rule out thrombocytopenia/coagulopathy if neuraxial is used
	\| considerations_intraoperative =		\| considerations_intraoperative = Fetal distress is common, may result in aborting procedure, or require urgent C section
	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}

	An '''external cephalic version''' is a maneuver performed by obstetric physicians to rotate a baby into vertex position in preparation for vaginal delivery. It may be done without any anesthesia, or with neuraxial (epidural, spinal, combined spinal epidural) depending on patient and provider preference.		An '''external cephalic version''' is a maneuver performed by obstetric physicians to rotate a baby into vertex position in preparation for vaginal delivery. It may be done without any anesthesia, or with neuraxial (epidural, spinal, combined spinal epidural) depending on patient and provider preference. The success rate of ECV varies from 45% to 65%.<ref>{{Cite journal\|last=Svensson\|first=Emelie\|last2=Axelsson\|first2=Daniel\|last3=Nelson\|first3=Marie\|last4=Nevander\|first4=Sofia\|last5=Blomberg\|first5=Marie\|date=2021-10-08\|title=Success rate of external cephalic version in relation to the woman’s body mass index and other factors—a population‐based cohort study\|url=http://dx.doi.org/10.1111/aogs.14270\|journal=Acta Obstetricia et Gynecologica Scandinavica\|volume=100\|issue=12\|pages=2260–2267\|doi=10.1111/aogs.14270\|issn=0001-6349}}</ref>

	== Overview ==		== Overview ==

Tony.Wang at 16:27, 27 October 2022

2022-10-27T16:27:17Z

← Older revision		Revision as of 09:27, 27 October 2022
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	\|-		\|-
	\|Airway		\|Airway
	\|		\|Airway edema is common in pregnant women near term
	\|-		\|-
	\|Neurologic		\|Neurologic
Line 45:		Line 45:
	\|-		\|-
	\|Hematologic		\|Hematologic
	\|		\|Thrombocytopenia is common and must be considered if neuraxial is required
	\|-		\|-
	\|Renal		\|Renal

Tony.Wang at 16:25, 27 October 2022

2022-10-27T16:25:00Z

← Older revision		Revision as of 09:25, 27 October 2022
Line 58:		Line 58:

	=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
	CBC ~~-- in~~ particular, ~~platelets~~ if neuraxial anesthesia will be used
			* CBC
			** In particular, evaluate platelet count if neuraxial anesthesia will be used

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
	~~Generally,~~ ECV is performed in a labor room or PACU area, where neuraxial anesthesia can be provided if needed~~. ECV can be performed~~ in the operating room ~~if there is a high risk~~ of requiring ~~emergent~~ [[Cesarean section]]. Having an operating room on standby and ready to use is prudent.		The ECV is often performed in a labor room or PACU area, where neuraxial anesthesia can be provided if needed, and in close proximity to the operating room in case of fetal distress requiring urgent [[Cesarean section]]. Having an operating room on standby and ready to use is prudent.

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
			Generally not needed

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

Tony.Wang at 16:22, 27 October 2022

2022-10-27T16:22:35Z

← Older revision		Revision as of 09:22, 27 October 2022
Line 9:		Line 9:
	}}		}}

	An '''external cephalic version''' is a maneuver performed by obstetric physicians to rotate a baby into vertex position in preparation for vaginal delivery.		An '''external cephalic version''' is a maneuver performed by obstetric physicians to rotate a baby into vertex position in preparation for vaginal delivery. It may be done without any anesthesia, or with neuraxial (epidural, spinal, combined spinal epidural) depending on patient and provider preference.

	== Overview ==		== Overview ==
Line 58:		Line 58:

	=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
			CBC -- in particular, platelets if neuraxial anesthesia will be used

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
			Generally, ECV is performed in a labor room or PACU area, where neuraxial anesthesia can be provided if needed. ECV can be performed in the operating room if there is a high risk of requiring emergent [[Cesarean section]]. Having an operating room on standby and ready to use is prudent.

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

			* An epidural or combined spinal epidural (CSE) can be offered for patients who wish to have analgesia, as the pressure applied to the abdomen can be quite significant and may prevent success of the maneuver.
			** Yoshida ''et al.'' reported a 78.8% success rate in patients who received an epidural compared to 55.9% success rate in patients who did not (OR: 1.75; 95% CI: 1.26 to 2.44).<ref>{{Cite journal\|last=Yoshida\|first=M\|last2=Matsuda\|first2=H\|last3=Kawakami\|first3=Y\|last4=Hasegawa\|first4=Y\|last5=Yoshinaga\|first5=Y\|last6=Hayata\|first6=E\|last7=Asai\|first7=K\|last8=Kawashima\|first8=A\|last9=Furuya\|first9=K\|date=2010-05-20\|title=Effectiveness of epidural anesthesia for external cephalic version (ECV)\|url=http://dx.doi.org/10.1038/jp.2010.61\|journal=Journal of Perinatology\|volume=30\|issue=9\|pages=580–583\|doi=10.1038/jp.2010.61\|issn=0743-8346}}</ref>
			* Spinal dose: bupivacaine ~7.5 mg intrathecally (~1 mL bupivacaine 0.75%)
			** CSE can be used to titrate up to effect
			* Epidural dose: lidocaine 2% ~10 mL

	== Intraoperative management ==		== Intraoperative management ==

	=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

			* EKG
			* pulse oximetry
			* NIBP
			* fetal HR monitoring

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
			Natural airway, oxygen (nasal cannula or mask) can be used for comfort if needed

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

			* Supine

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
			If an epidural is used, additional titration may be needed to tolerate the procedure. Careful observation of blood pressure is important as hypotension is common. Maintaining uterine artery blood flow is critical to avoiding fetal distress.
	~~=== Emergence<!-- List and/or describe any~~ important ~~considerations related~~ to ~~the emergence from anesthesia for this case~~. ~~--> ===~~

	== Postoperative management ==		== Postoperative management ==

	=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
			Generally, the fetus is monitored for several hours. If neuraxial anesthesia is used, patient must regain motor and sensory function.

	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
			Generally, the procedure has minimal pain once completed. The epidural, if placed, can be titrated as needed

	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
			There is imminent risk of fetal distress with the ECV, thus there should always be an available operating room for emergent [[Cesarean section]].

	== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

Tony.Wang at 15:25, 27 October 2022

2022-10-27T15:25:49Z

← Older revision		Revision as of 08:25, 27 October 2022
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	\| airway = Natural		\| airway = Natural
	\| lines_access = 1 PIV		\| lines_access = 1 PIV
	\| monitors = Standard ~~ASA~~ monitors		\| monitors = Standard OB bedside monitors (EKG, pulse ox, NIBP, fetal HR monitoring)
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative =		\| considerations_intraoperative =

Tony.Wang: page creation

2022-10-27T14:24:01Z

page creation

New page

{{Infobox surgical procedure
| anesthesia_type = None or epidural/CSE
| airway = Natural
| lines_access = 1 PIV
| monitors = Standard ASA monitors
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

An '''external cephalic version''' is a maneuver performed by obstetric physicians to rotate a baby into vertex position in preparation for vaginal delivery.

== Overview ==

=== Indications ===

* Breech or transverse presentation
** Ideally around 36-37 weeks gestation before the baby is too large

=== Surgical procedure ===
The maneuver can be performed at bedside using external force on the abdomen to rotate the baby. Ultrasound is used to confirm head position before, during, and after the maneuver. Fetal heart rate monitoring is used to closely monitor for fetal distress

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]