Obstetrics and Gynecology - A.M. Gromova 2000

Operative Obstetrics
Obstetric Version
External Obstetric Version

This Procedure is performed in cases of transverse, oblique, or breech presentation of the fetus in order to turn the fetus to a cephalic presentation.

Sometimes, THE POSITION OF the fetus in transverse or oblique lie can be corrected without surgical intervention. To achieve this, the woman should lie on the side toward which the fetal HEAD is turned. In cases of breech presentation, pregnant women from 26 weeks of gestation are recommended to perform Dykany's exercises: on a firm couch or the floor, with an empty Stomach, the woman should turn from one side to the other every 10 minutes, three times a day for one hour. In such cases, the fetus often turns spontaneously. In instances where the fetal position cannot be corrected in this manner, an external cephalic version is indicated.

Conditions for the procedure:

1. Gestation of 34–36 weeks, living fetus.

2. Compliance and absence of tension in the abdominal wall and uterine walls.

3. Normal dimensions of the pregnant woman's pelvis.

4. Mobility of the fetus.

5. Consent of the pregnant woman.

Contraindications to the procedure:

1. Complications of Pregnancy accompanied by bleeding or the threat of termination.

2. History of spontaneous Miscarriage or preterm labor.

3. Polyhydramnios and oligohydramnios.

4. Multiple gestation.

5. Contracted pelvis, scars, or tumors of the Vagina that prevent spontaneous delivery.

6. Complications of pregnancy and extragenital pathology in the stage of decompensation.

7. Uterine scar.

8. Anomalies of uterine and fetal development.

The procedure is performed exclusively in a hospital Setting after emptying the Urinary Bladder and bowels. The woman lies supine on a firm couch. Anesthesia is contraindicated. The administration of 2 ml of No-shpa, 1 ml of 1% promedol solution, or 1 ml of 0.1% atropine solution 20–30 minutes prior to the procedure is permissible.

Technique of the external version procedure

Sitting to the right of the patient, the obstetrician places their hands on the woman's abdomen so that one hand grasps and holds the fetal head, while the other holds the breech.

External prophylactic version is most appropriately performed according to B. A. Arkhangelsky. The direction of movement should be from the breech toward the fetal back, from the back toward the head, and from the head toward the chest, leading into the pelvic inlet. This technique helps prevent The formation of deflexion presentations. Thus, in breech presentation, the fetus should be turned by 180°; in the POSTERIOR VIEW OF a transverse lie (when the fetal back is turned toward the uterine fundus) by 90°; and in the anterior view of a transverse lie (when the back is turned toward the pelvic inlet) by 270°, in order to convert the fetus first into a breech and then into a cephalic presentation. If pain, uterine tension, or tension of the abdominal wall occurs during the version, the manipulation should be halted until complete relaxation of the organ is achieved. After the version is completed, fetal Heart sounds are auscultated. They may become somewhat accelerated, but should return to normal within 1–2 minutes. If the version of the fetus from a transverse or oblique lie is successful, bandaging with rolls placed on both sides of the abdomen is indicated to fix the fetus in its new position. Until delivery, the woman remains under systematic observation.