VERSION

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DEFINITION OF VERSION:

It is changing the transverse lie to a longitudinal one or Defining version


Roller
To define replacement the presenting pole by the other. If the aim is to make the
1. 1 min board Define version
version head the presenting part it is called cephalic version and if the breech
Listening
will be the presenting part it is podalic version.

2. 3 mins To list the types TYPES OF VERSION: Listing the types Bulletin What are the types
of version of version board of version?
1. Spontaneous version

2. External version, usually cephalic.

Listening
3. Internal podalic version.

4. Bipolar podalic version.

Spontaneous Version: Version process occurs spontaneously .The


incidence of spontaneous version in breech presentation is nearly 55%
after 32 weeks and about 25% after 36 weeks. It is more common in
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multiparous women.

External Version: The maneuver is done solely by external Listing the types
To list the types manipulation. of version
of version Bulletin What are the types
Internal Version: The conversion is done principally by one hand board of version?
introducing into the uterus and the other hand on the abdomen.
Listening
Bipolar (Braxton –hicks): The conversion is done introducing one or
two fingers through the cervix and the other hand on the abdomen.
EXTERNAL CEPHALIC VERSION

DEFINITION:
To explain about Explaining about
external cephalic It is done to bring the favorable cephalic pole in the lower pole external cephalic PPT What is external
3. 2 mins version of the uterus. version cephalic version?

INDICATIONS:

Listening
 Breech presentation.
 Transverse or oblique lie.

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PROCEDURE OF EXTERNAL CEPHALIC
VERSION:

No anaesthesia as the pain is a safe guard against rough


Describing the
manipulations.
To describe the procedure of
The patient evacuates her bladder.
procedure of external cephalic PPT
4. 2 mins She lies in a Trendelenburg position with exposed vulva to
external cephalic version What is the
detect any vaginal bleeding.
version procedure of
The fetal position is determined and FHS is auscultated.
external cephalic
One hand is applied externally to the fetal head and the other
version?
on its buttock, the two poles are approximated to flex the
foetus and rotation is done by the two hands simultaneously to
bring the head lower down. Listening
The FHS is auscultated again, if there is fetal distress lasting
for more than 5 minutes, the fetus is returned back to its
previous position as the cord might be coiled or entangled
around the neck.
If neither vaginal bleeding nor foetal distress results, an

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abdominal binder is applied to fix the new position and re-examined
twice weekly. If the original presentation returned again, the
procedure of version can be repeated.
INTERNAL PODALIC VERSION

Definition: Discussing about


internal cephalic
Internal version is always a podalic version and is almost always
version
To discuss about completed with the extraction of the fetus. PPT What is internal
5. 3 mins internal podalic podalic version?
Indications
version

 Retained second twin in a transverse lie.


Listening
 Some cases of shoulder presentation.
Prerequisites

 General anaesthesia to guard against pain and give uterine and


pelvic relaxation.
 Evacuation of the bladder.

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 Complete aseptic conditions.
 Cervix is fully dilated.
 Uterus is not tonically contracted.
 No previous uterine scar.
 Adequate liquor amnii (intact or recently ruptured
membranes).
 No obstruction to vaginal delivery whether maternal as
contracted pelvis or fetal as hydrocephalus.

PROCEDURE OF INTERNAL PODALIC


Describing the
VERSION:
procedure of What is the
To describe the internal podalic procedure of
6. 2 mins procedure of version internal podalic
Lithotomy position. PPT
internal podalic version?
Episiotomy for primigravida.
version
The hand is introduced through the cervix into the uterus and Listening
grasp the lower foot if the back is anterior and the upper foot if
the back is posterior, so that the back is kept anterior during
delivery.
The other hand is pushing the head upwards while the foot is

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brought downwards.

The other foot is brought down and breech extraction is done.


The birth canal is explored after delivery for possible injuries.

COMPLICATIONS OF INTERNAL PODALIC


VERSION

Maternal: Enumerating the


complications of What are the
To enumerate  Shock (in light anaesthesia) internal podalic Chart complications of
7. 2 mins the  Premature separation of the placenta. version internal podalic
complications of  Rupture uterus.                          version?
internal podalic  Cervical lacerations.
version  Postpartum haemorrhage.       
 Puerperal sepsis. Listening

Foetal:

 Asphyxia due to premature separation of the placenta

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or entangling of the cord.

 Complications of breech delivery

BIPOLAR PODALIC VERSION

It is outmoded of modern obstetrics.

Indications: Explaining about


8. 3 mins
To explain about bipolar podalic PPT
bipolar podalic version What is bipolar
It was done in a partially dilated cervix for:
version podalic version?

 Correction of a transverse lie in a dead or markedly premature


foetus.
Listening
 Compression of placenta previa.

Complications

As internal podalic version but higher in incidence due to the


partially dilated cervix and presence of the placenta lower down in
case of placenta praevia.
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PROCEDURE OF BIPOLAR PODALIC VERSION:
Discussing the
To discuss the Under general anaesthesia procedure of What is the
9. 2 mins
procedure of 2 fingers are passed through the partially dilated cervix bipolar podalic PPT procedure of
bipolar podalic The foot is grasped, as in internal podalic version, pulled version bipolar podalic
version through the cervix while the other hand is assisting the version version?
externally.
Listening

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