Question

Case Study: External Cephalic Version Followed by Induction of Labor

Maya is a 29-year-old G3P2 who arrives at the labor and delivery unit for an external cephalic version (ECV) at 39 weeks and 4 days. Her obstetric history is negative. Her other two births were full-term and uncomplicated normal births. Her medical-surgical history is negative. In the present pregnancy, the fetus was found to be in breech position today at her clinic visit. There have been no other problems in her pregnancy. She expresses fear of the procedure that is to be done, but she also expresses a strong desire to avoid a cesarean birth. She has had no symptoms of labor and denies spontaneous rupture of membranes.

1. What are some contraindications to ECV?

procedure, then the procedure should not be performed; it will further stress the fetus.

2. What nursing care is indicated before the procedure?

3. The ECV was successfully performed, and now Maya and her provider elect to induce labor at patient request because she is afraid the baby might turn again. Maya’s cervix is soft, anterior, fingertip dilated, and long, with the vertex now at −3 station. What method of induction of labor would be most appropriate?

4. The physician inserted a Foley catheter through the cervix and inflated it with 40 mL of normal saline for cervical ripening. Five hours later, Maya calls the nurse and states that the catheter has fallen out. What is the most likely explanation for the expulsion of the catheter?

5. Maya is now dilated 4 cm/60% effaced and the vertex is at −3 station. The physician has ordered oxytocin infusion per protocol. What nursing actions demonstrate safe use of oxytocin?

Answer 1

Ans: 1.Placenta praevia, Intrauterine growth retardation, isoimmunization, fetal or uterine anomalies, excessive vaginal bleeding are the contraindications.

2.Fetal monitoring should be done with fetal heart rates before ECV.

Place mother in a comfortable position.

Check for qny contraindications or bleeding.

Ultrasonography should be kept ready.

It should be done near delivery room.

All arrangements for caesarian section to be done, if ECV fails it should be done immediately to prevent complications for mother and baby.

3 induction of labour with dinoprostone vaginal suppositories can be made.

4.Catheter falls out is a good sign showing cervical ripening.

5.Monitor the rate and rhythm of uterine contractions and uterine response.

If contractions are prolonged stop infision and inform physician to prevent fetal distress.

Check for water intoxication confusion, headaxhe, anuria

Check maternal pulse, BP and fetal heart rates also.