Question

The most challenging concept for me to understand the version. There are two types external and internal. For the external version how does that work when the woman’s abdomen might be hard shell, and the HCP has to help change the fetus’s presentation. Also, for the internal version I had no clue but I learnt that  it was used for twin gestation to help with cesarean birth. Like do they cut up the mother and pull out the fetus in a transverse way or I can’t understand that concept. Please provide your reference.

Answer 1

external version-version, is a procedure used to turn a fetus from a breech position or side-lying (transverse) position into a head-down (vertex) position before labor begins.

Before the version attempt, you may be given an injection of tocolytic medicine to relax the uterus and prevent uterine contractions. The most commonly used tocolytic medicine is terbutaline.

While the uterus is relaxed, HCP will attempt to turn the fetus. With both hands on the surface of your abdomen—one by the fetus's head and the other by the buttocks—the doctor pushes and rolls the fetus to a head-down position. patient will feel discomfort during a version procedure, especially if it causes the uterus to contract

Version may be attempted when:

• The mother is 36 to 42 weeks pregnant. Before 36 weeks, a fetus is likely to turn back into a head-down position on its own. But version may be more successful if it is done as early as possible after 36 weeks because the fetus is smaller and is surrounded by more amniotic fluid and space to move in the uterus.
• The mother is pregnant with only one fetus.
• The fetus has not dropped into the pelvis (has not engaged). A fetus that has engaged is very difficult to move.
• There is enough amniotic fluid surrounding the fetus for turning the fetus. If the amount of amniotic fluid is below normal (oligohydramnios), the fetus is more likely to be injured during a version attempt.
• The mother has been pregnant before. A previous pregnancy usually means that the wall of the abdomen is more flexible and can stretch during a version attempt. Version may also be attempted if the mother has not been pregnant before.
• The fetus is in the frank, complete breech, or footling breech position

.During internal version the accoucheur completes a series of manoeuvres with one hand inside the uterus, usually with the aim of bringing one or both feet through a fully dilated cervix, hence the term internal podalic version.

its indications are limited to the delivery of a second twin presenting in a transverse or oblique manner. In this situation, it may reduce the need for caesarean section and reduce maternal morbidity without having a negative impact on the condition of the neonate.

procedure

1. pt should be in lithotomy position.
2. the hand is introduced through the cervix into the uterus to grasp the lower foot of the fetus, if the backis anterior and upper foot if the back is posterior.so that the back is kept anterior during the delivery.
3. the other hand is pushing the head upwards while the foot is brought downwards
4. the other foot is brought down ward and breech extraction is done
5. the birth canal is explored after delivery for any birth injury