External Cephalic Version (ECV) - Clyde Standard Operating Procedure

Women can be booked for ECV through RAH Maternity Daycare on 0141 314 6724 (06724).

Important points for booking

• Arrange an ECV for Primiparous from 36 weeks gestation and Multiparous from 37 weeks gestation
• Daycare can accommodate one ECV per day – admitted at 1430
• Aim to prioritise ECVs on Monday, Wednesday and Friday (full day section lists run on Tuesday and Thursday)
• Friday capacity is dependent on whether the on-call consultant perform ECVs – daycare team to review consultant on call rota to advise
• Advise the woman to have a light breakfast in the morning.  There is no requirement for a pre-operative assessment for this procedure.

Equipment required:

• CTG machine
• Ultrasound machine – clinic ultrasound machine should be used and brought to day care
• Consent form and drug kardex
• Terbutaline (Bricanyl) 1ml Ampoule (0.5mg/ml)
• 1ml Syringe and appropriate size needles

Pre –procedure checklist:

• Admit to day care bay bed space
• Maternal Pulse and BP
• Check maternal blood group is recorded
• 20 minute CTG prior to ECV
• Bedside USS to confirm breech presentation
• Documented written consent
• Prescribe and administer Terbutaline 250 micrograms (0.5ml of 0.5mg/ml) subcutaneously . Administer 10 minutes prior to ECV.  NB: caution in patients with PET and diabetes, contraindicated in cardiac disease.
• Check maternal pulse 5 minutes after Terbutaline administration

During the procedure:

• Advise patient to relax and breath slowly
• Offer Entonox during the procedure.
• Lie patient flat and offer wedge if not tolerated.
• ECV can be attempted for up to 10 minutes and is also dependent on patient tolerance.
• Check FH intermittently with Doptone or ultrasound
• Bradycardia following ECV is common and should not last longer than 3 minutes. If persisting beyond that prepare for category 1 CB.
• Bedside USS to confirm fetal presentation following ECV attempt

• Perform a repeat CTG
• If successful
  • Sit the woman up and consider adopting a cross-legged position to encourage engagement of the fetal head
  • Discuss awaiting spontaneous delivery unless any indication IOL
• If unsuccessful discuss
  • Repeat attempt at a later date at discretion of consultant Obstetrician
  • Caesarean birth – complete consent and badger referral
• If Rhesus Negative post-procedure: offer Anti-D and take a Kleihauer blood. If Kleihauer is strongly positive, offer re-review.

Follow-up: palpation at next CMW appointment within 1 week of ECV.

• Contact labour ward to identify an appropriate day to perform the procedure (based on consultant availability) and the clinical situation. Ensure is “booked” in LW diary.
• An inpatient ECV can be performed on the antenatal ward using the above stepwise approach
• A stabilising induction is a higher risk procedure and routinely involves a controlled artificial rupture of membranes in theatre. Please ensure the woman and ward staff have specific instructions regarding fasting prior to procedure.