Managing Complications in Pregnancy and Childbirth: - IAWG

EXTERNAL VERSION P-15• Review for indications. Do not perform this procedure before 37weeks.• Have the woman lie on her back, and elevate the foot of the bed.• Listen to and note the fetal heart rate. If there are fetal heart rateabnormalities (less than 100 or more than 180 beats per minute), donot proceed with external version.• Palpate the abdomen to confirm presentation and position of thefetal head, back and hips.• To mobilize the breech, gently lift the lowest part of the fetus fromthe pelvic inlet by grasping above the pubic bone (Fig P-5 A, pageP-16).• Bring the head and buttocks of the fetus closer to each other toachieve forward rotation. Rotate the fetus slowly by guiding thehead in a forward roll as the buttocks are lifted (Fig P-5 B–C, pageP-16).• Listen to the fetal heart rate. If an abnormality is detected:- Have the woman turn on to her left side;- Give oxygen at 4-6 L per minute by mask or nasal cannulae;- Reassess every 15 minutes.• If the procedure is successful, have the woman remain lying downfor 15 minutes. Counsel her to return if bleeding or pain occurs or ifshe believes the baby has returned to the previous presentation.• If the procedure is unsuccessful, try again using a backward roll(Fig P-5 D).• If the procedure is still unsuccessful and fetal heart rate is good,tocolytics may increase the chances of successful version. Give:- terbutaline 250 mcg IV slowly over 5 minutes;- OR salbutamol 0.5 mg IV slowly over 5 minutes.• If the procedure is still unsuccessful, attempt version again after 1week or if the woman presents in early labour with breech ortransverse lie.• If there are fetal heart abnormalities:- Turn the woman onto her left side;