Full bladder aids
cephalic version
Fetal hydrofloation boosts success rates of external version by Jenny Manzer
SAN FRANCISCO - A novel technique dubbed "fetal hydroflotation" boosts success rates for external cephalic version, researchers from Israel report.
External cephalic version is traditionally done with an empty maternal bladder.
Lead researcher Dr. Raphael Pollack speculated that if the mother-to-be filled her bladder, it could act as a "hydrostatic wedge," gradually lifting the fetus from the pelvis to facilitate version.
"One of the causes for failures for external cephalic version is if the baby is deeply wedged in the pelvis. My idea was if you could un-impact the baby out of the pelvis you'd improve your success rates," said Dr.
Pollack, director of obstetrics at the Bikur Cholim Hospital in Jerusalem.
The team performed the technique 188 times on 182 patients who had breech presentation at term. The women were given ritodrine (Yutopar) 10 mg intramuscularly to relax the uterus 15 minutes before the procedure.
Patients were then asked to drink 10 glasses of water to fill their bladders. Version was performed using the forward roll technique, and attempted no more than three times.
Version was successful in 144 of 188 attempts (77%). In six patients, the procedure was performed twice because the fetus reverted to breech presentation after successful version. Version failed in 42 women (23%).
The reported success rate of external cephalic version is about 58%, according to figures from the American College of Obstetricians and Gynecologists.
Based on the Israeli success rate of 77%, Dr. Pollack suggested fetal hydroflotation could be a useful adjunct to version.
Most (92%) of the 182 patients who had a successful version went on to vaginal delivery, compared to just 17% in the group for whom version failed.
Only 8% of the successful version group went on to C-section, compared to 83% in the failed group.
Dr. Pollack said the women were pleased with the technique, and adverse events were "few and far between."
Complications of external cephalic version included one case of variable decelerations in the fetal heart rate, and one of antepartum bleeding.
Dr. Pollack admitted having a full bladder caused the women some discomfort. "They were uncomfortable, but the version itself even without the filled bladder is an uncomfortable procedure. "(The women) were willing to do it because when you explain to them they'll be less uncomfortable than they would be with a cesarean delivery, they appreciate that."
Sonographic examination and non-stress testing were done before and after the procedure. Subjects all had singleton pregnancies with no contraindications to vaginal delivery.
The study took place from February 1999 to January 2003.
In another poster presented here, Dr. Pollack suggested adopting a policy of universal external cephalic version at term for all
non-cephalic presenting fetuses could have a substantial impact on U.S. C-section rates, as well as providing a tangible benefit to maternal health.
A policy of universal external cephalic version could save the U.S. health-care system as much as $383,886,000 US annually, according to the study.