Thursday, June 27, 2013

external cephalic version



                                   



Tahukah anda "pusingan bayi dari songsang menjadi kepala dibawah”atau dikenali sebagai "external cephalic version" adalah procedure lama yang telah praktikkan oleh bidan kampunng zaman dulu?  Bezanya ianya bukan lagi dilakukan oleh mak bidan tetapi oleh doctor terlatih dibawah pengawasan ultrasound,CTG dan dewan pembedahan.

 ECV ini dilakukan pada usia kandungan 36 hingga 37 minggu kerana awal dari itu bayi akan pusing balik menjadi songsang dan kalau lewat pula, ia sukar dilakukan kerana air ketuban telah pun berkurangan.

Namun apa yang lebih  penting di sini adalah jika berlaku komplikasi semasa ECV yang memerlukan bayi dilahirkan secara caesarean!

Sebab itu ECV mesti dilakukan oleh yang telah terlatih,dihospital yang ada dewan bedah dan pemantauan bayi dengan CTG.

Peratus berjayanya external cephalic version ini mengubah bayi songsang  adalah 50% dan dengan ini ia mampu mengurangkan setengah dari risiko caesarean. Namun kira-kira 3 % akan pusing balik menjadi songsang. Anda juga perlu tahu bahawa tidak semua ibu yang mempunyai kandungan songsang boleh melakukan ECV.

Jadi mari kita BACA sedikit info tentang External Cephalic Version dari buku department O n G ;



 EXTERNAL CEPHALIC VERSION


Def: a procedure designed to substitute one pole of the fetus by the other. The idea is to make cephalic delivery which is safer for the mother and infant..
Time: best 34-36 weeks

Before 34 weeks: 1.spontaneous version may occur
                              2. Recurrence after correction
                              3. Precipitate premature delivery
                              4. After delivery, difficult technique due to
                                                a)decrease amount of amniotic fluid
                                                b)increase size of uterus
                                                c) uterus more irritable and sensitive 4 manipulation


Prognosis: succeeds in about 75% primigravidas and 95% of multiparas

Aims & Advantages : 1. Decrease of fetal mortality & morbidity
                                    2. Decrease of maternal morbidity
                                    3. Test for cephalopelvic disproportion
                                    4. Decrease of CS rate

Preparations: 
1. Patient lies with moderate Trendlerberg's position ( tp dlm video atas x guna pun cara ni)
2. Bladder & rectum empty
3. Vulva uncovered to detect any vaginal bleeding

Technique:
          one hand grasping the head and the others graps the breech

         1st step : displace the breech into one or other iliac fossa after listen to FHS
         2nd step: push head down towards the pelvis and breech upward towards fundus. this turn fetus                                  transverse lie.
         3rd step: head pushed over pelvic brim & breech pushed up towards fundus
         4rd step: push head down into brim as low as possible by grasp with 2 hand
         Finally   : press upon fundus so as to push whole fetal body as low down as possible.

Failure of external cephalic version:

1. Extension of legs (commonest cause) as leg act as splints. Failure occurs in 50% of cases of breech with extended legs.
2. Obesity
3. Rigid abdominal wall
4. Irritable Uterus
5.Uterine abnormalities as bicornuate
6.Deficient or excessive liquor
7.Short umbilicus cord
8.Oversized fetus
9.Twins

Complications of external version :

1.Partial separation of the placenta leading to accidental haemorrhage
2.Rupture of membranes and premature labor
3.Fetal shock
4.Cord presentation and prolapse or entanglement of the cord around the fetus
5.Fetal mortality rate is about 2%

Contraindications of external version:

1.Antepartum Haemorrhage
2.Hypertension ( the placenta is liable to separation)
3.Marked contracted pelvis (CS will be done)
4. Twins
5.Scars in the uterus
6.Hydrocephalus
7.Elderly primigravida ( above 35 years)


Sudah faham tentang EVC? semoga penjelasan ini dapat membantu anda.
Bagaimana pula dengan IPV iaitu internal podalic version? Jom sama2 discuss dan research..




1 comment:

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