[External cephalic version using tocalytica (author's transl)].

Abstract

1. This report relates our experiences with 63 external versions of random breech or transverse presentations in cranial presentation between the 35th and 40th week of pregnancy p.m. using tocolytica. Only 22 of the 63 versions were successful when only tocolytica were administered. In 17 cases from a total of 34 the external version was successful under subsequent general anasthesia. 2. Of these 39, in whose case an external version of the foetus was successful, there were only two caesarian deliveries. The number of caesarian sections in the case of breech presentation on the other hand totalled, in the year the present investigation was carried out, 62%. By external version the number of caesarian sections performed on those women whose external version was successful was indirectly reduced twelve-fold. 3. It was not possible to turn 24 of the total of 63 foetuses - either by tocolytica or under general anaesthesia. The following factors - partly in combination - were responsible for this: 10 tendencies to contraction; 9 cases of a relatively narrow amniotic cavity: 3 cases of adiposity of the abdominal wall; 3 dorso-anterior or -posterior presentations; one case of "extended legs"; one relatively broad amniotic cavity. 4. An external version can cause damage to the placenta: a) in the case of 6 out of 22 women under obervation foetomaternal transfusion was detected. b) In once case materno-foetel transfusion with polyglobulism of the new-born was suspected. c) In one case a premature partial abruption of the placenta had to be assumed. The danger of damage to the placenta is especially great when the placenta is located next to the anterior wall of the uterus. 5. In 40% of the cases a brief deceleration of the foetal heart-frequency occurred immediately after the external version. Two cases were observed in which the foetal heart-frequency remained low over a period of several minutes. 6. In 5 out of the total of 63 cases a caesarian section was performed after the external version because of the danger of intra-uterine asphyxia. There were 4 cases of chronic insufficiency of the placenta and one of premature abruption of the placenta. 7. Suggestions are made concerning the future selection of breech presentations for external versions.