External cephalic version
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|External cephalic version|
External cephalic version is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. It is usually performed after about 37 weeks. It is often reserved for late pregnancy because breech presentation greatly decreases with every week.
It can be contrasted with "internal cephalic version", which involves the hand inserted through the cervix.
In this procedure hands are placed on the mother's abdomen around the baby. The baby is moved up and away from the pelvis and gently turned in several steps from breech, to a sideways position, and finally to a head first presentation.
External cephalic version performed before term may decrease the rate of breech presentation compared to external cephalic version at term, but may increase the risk of preterm delivery.  There is some evidence to support the use of tocolytic drugs in external cephalic version.  Use of intravenous nitroglycerin has been proposed.
Complications and risks
As with any procedure there can be complications most of which can be greatly decreased by having an experienced professional on the birth team. An ultrasound to estimate a sufficient amount of amniotic fluid and monitoring of the fetus immediately after the procedure can also help minimize risks.
Typical risks include umbilical cord entanglement, abruptio placenta, preterm labor, premature rupture of the membranes (PROM) and severe maternal discomfort. Overall complication rates have ranged from about 1 to 2 percent since 1979. While somewhat out of favor between 1970 and 1980, the procedure has seen an increase in use due to its relative safety.
Successful external cephalic version significantly decreases the rate of cesarean section, however women are still at an increased risk of instrumental delivery and cesarean section compared to women with spontaneous cephalic presentation.
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