External Cephalic Version (ECV) is a medical procedure to turn a breech baby into a head-down position before labor begins. Its goal is to increase the likelihood of a vaginal birth, potentially avoiding a Cesarean section. An anterior placenta is located on the front wall of the uterus, between the baby and the mother’s abdomen. This is a common and normal placental position. This article explores ECV when an anterior placenta is present.
Understanding ECV and Anterior Placenta
The procedure aims to encourage a breech baby to turn to a head-down (cephalic) presentation, which is preferred for vaginal delivery. This procedure is typically attempted around 37 weeks of pregnancy, as babies are less likely to turn on their own after this point.
An anterior placenta is a common and normal position, occurring in about 50% of pregnancies. The placenta, a temporary organ, develops where the fertilized egg implants in the uterine wall and provides oxygen and nutrients to the growing fetus while removing waste products.
Considerations and Safety of ECV with Anterior Placenta
An anterior placenta introduces specific considerations for an ECV, though it is generally still regarded as a safe option when performed by experienced practitioners under careful monitoring. An anterior placenta can create a cushioning effect between the baby and the mother’s abdomen, potentially making it more challenging for the practitioner to feel the baby’s head and body during manipulation. This cushioning might require the practitioner to apply slightly more pressure or adjust their technique.
A theoretical, though generally low, risk to the placenta during ECV is placental abruption, where the placenta separates from the uterine wall. Close monitoring helps mitigate this risk. Some studies suggest an anterior placenta might slightly hinder fetal head palpation, potentially influencing the ease of the procedure. Despite these considerations, medical professionals often proceed with ECV in cases of anterior placenta, emphasizing continuous fetal heart rate monitoring and readiness for an emergency Cesarean section if complications arise.
Success Rates and What to Expect
The overall success rate for ECV typically ranges from approximately 50% to 70%. However, an anterior placenta can influence these rates, with some studies indicating slightly lower success rates compared to a posterior placenta. Factors such as the practitioner’s experience, the baby’s exact position, and the amount of amniotic fluid present also play a role in the likelihood of a successful turn.
During an ECV, the procedure typically begins with an ultrasound to confirm the baby’s breech position, the placenta’s location, and the amount of amniotic fluid. Fetal heart rate monitoring is conducted before, during, and after the procedure, often for 20 to 40 minutes. Medication, such as terbutaline, may be administered to relax the uterus, which can improve the chances of a successful turn.
The practitioner then applies gentle, firm pressure to the abdomen to guide the baby into a head-down position, often attempting a forward somersault maneuver first. The procedure itself usually lasts only a few minutes, though the entire process, including monitoring, can take up to two hours. If the baby successfully turns, follow-up monitoring is performed, and there is a small possibility the baby could turn back to a breech position.