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Old 08-07-2013
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ObGyn OB/Gyn Questions #2

At 39 weeks gestation a woman comes to the L&D unit on labor. She is 50 % effaced and 2 cms dilated. a 36 weeks ultrasound showed the fetus to be in transverse lie. When you perform Leopold maneuvers you notice the fetus is now on breech presentation, after confirming the diagnosis with a new USG what is the best course of action?
A. C-Section.
B. Cephalic external version.
C. Oxytocin augmentation.
D. Observation and reassurance.
E. Methylergonovine induction.
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Old 08-07-2013
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Breech position. C-section?
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Old 08-07-2013
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Ans B . this should be given a try first
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Old 08-07-2013
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the lady is in first stage labor with breech, i would go for C section.

To my knowledge,external cephalic version is done prior to the onset of labor and after 37 weeks with breech baby
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Old 08-07-2013
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Quote:
Originally Posted by XpaezX View Post
At 39 weeks gestation a woman comes to the L&D unit on labor. She is 50 % effaced and 2 cms dilated. a 36 weeks ultrasound showed the fetus to be in transverse lie. When you perform Leopold maneuvers you notice the fetus is now on breech presentation, after confirming the diagnosis with a new USG what is the best course of action?
A. C-Section.
B. Cephalic external version.
C. Oxytocin augmentation.
D. Observation and reassurance.
E. Methylergonovine induction.
I say B. Try for a external version and if it doesn't work or something goes wrong post for c-section.

But I am confused about whether its ok to do Cephalic versions when labor has already begun....
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Old 08-08-2013
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A C section
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Old 08-08-2013
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The correct answer is A.
As anomali correctly said, you dont perform especial accommodation maneuvers when labor as already begun, is just not worth it (the morbidity is too high.. also try to move a fetus along with contractions and lets see what happens).
The best course of action here is to go directly into C-section.

Good job!
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Old 07-12-2014
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Default CEV

from Medscape online:
External cephalic version (ECV) is a safe alternative to vaginal breech delivery or cesarean delivery, reducing the cesarean delivery rate for breech by 50%. ACOG (2000) recommends offering ECV to all women with a breech fetus near term.Adjuncts such as tocolysis, regional anesthesia, and acoustic stimulation when appropriate may improve ECV success rates.
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