Mar 31, 2011

life's a breech

One of the reasons for the rising rate of Caesarean Section was the declining vaginal breech delivery following the post-Hannah term breech trial era. And the skills and attempts for external cephalic fortunately still alive, but skeptically was not attempted that enthusiastically because of the accompanying complications, or rather due to the nature of human. It is the nature of human to fear what we can’t see, what we can’t explain and what we have to wait and wait to finally hold the breath of relief.

To go through with the abdominal delivery, things are definitive. Cut, baby out, close. Baby alive and kicking. No waiting game.

My first clinical encounter with regards to ECV was an intrauterine death following ECV by my specialist few years back in my previous hospy. Subsequently, which I vividly remembered, even a presentation of advocacy of ECV following Green top guideline by my respected senior medical officer and further encouragement by the departmental leader wasn’t enough to turn the tide over. The idea of ECV was usually shot down prematurely during the counselling of options and followed closely with the overemphasis of the fetal heavenly safety with the Caesarean.

In this hospy, the best (informally recognized) cephalic versionist was a junior of mine, yet his tai-chi kungfu is well-known. His first successful ECV promised the mother the safety path away from the horror of Caesarean gone wrong, only to have death clenching tightly on the mother through a motor vehicle accident in the famous Tun’s highway. And this maternal death went to the media, for a common reason why so many things in life went to media - politicized, and not because of its close resemblance to the movie ‘Final destination’.

My first attempt with ECV was few months back with the great specialist-teacher, Dr. S. It was a successful attempt simply because she intervened at the point where the lie was tranverse and resistance was at its maximum.

My second attempt was during last Saturday. She came in with weak contractions. The mother and her husband weren’t so keen on Caesarean for reasons only known to them. I went through her antenatals and subject her to careful sonographic assessment, simply to exclude any contraindications or factors that will reduce the success rate. I treaded on cautious ground, as I made sure the couple fully understood all the risks and the subsequent possibility of Caesarean. An ECV which probably equivalent to nose-picking to others, started to be appear like a complicated vascular surgery to me.

As I swept my hands at both the lateral sides, within few minutes, the version completed.


Fetal health reassured with the immediate cardiotocogram. But the head is still floating.

I spared the couple of false hope, telling them that the fetal head might still turn back up.

Fortunately, it didn’t.

She was induced for prolong leaking and subsequently delivered vaginally uneventfully today.

My advice for her before discharge - make sure who ever driving, to drive carefully.

Yes, at times, the roads can be more lethal than going under the knife.

At least, intraoperatively, thanks to the ever-ready anaest colleagues, one will be pain-free.

Now, that’s my brief story of me and ECV.

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