The external cephalic version is commonly used to manage:

DSSSB 14 August 2024

Obstetrics & Gynaecology

Easy

Appeared in: DSSSB 14 August 2024

Explanation

External Cephalic Version (ECV) is a non-invasive procedure where a healthcare provider applies pressure to the mother's abdomen to turn a fetus from a breech or transverse position to a head-down (cephalic) position.
The primary goal of ECV is to increase the chances of a vaginal delivery and avoid the risks associated with a cesarean section for malpresentation.
Breech presentation, where the baby's buttocks or feet are positioned to be delivered first, is the most common indication for performing an ECV.
The procedure is typically performed near term, around 37 weeks of gestation, to balance the chances of success with the risks of preterm delivery if complications arise.

Option A: Anencephaly is a severe neural tube defect, which is a structural congenital anomaly. ECV is a procedure to correct fetal position, not to treat or manage birth defects.
Option C: Placenta previa, where the placenta covers the cervical opening, is an absolute contraindication for ECV. Attempting the procedure poses a high risk of placental disruption and severe hemorrhage.
Option D: Hydrocephalus is a congenital condition involving excess fluid in the fetal brain. ECV is irrelevant for managing this condition, as it only addresses the fetus's physical orientation in the uterus.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Fetal Malpresentation using External Cephalic Version (ECV) as background academic context rather than a clinical decision trigger.
The nurse's role during an ECV is critical. It includes preparing the patient, administering tocolytic medications as prescribed to relax the uterus, and continuously monitoring the fetal heart rate and maternal vital signs before, during, and after the procedure to detect any signs of distress.
Patient education is a key nursing responsibility. The nurse must explain the procedure, its risks (e.g., placental abruption, cord compression, preterm labor), benefits (potential to avoid cesarean section), and the possibility of failure or reversion.
What if? If the fetus shows signs of distress (e.g., persistent bradycardia) during the ECV attempt, the procedure is stopped immediately. The nurse should be prepared for an emergency cesarean delivery if the fetal heart rate does not recover.

How to Approach the Question

First, identify the key term in the question: 'External cephalic version' (ECV).
Recall the definition and primary purpose of this procedure. ECV is a manual maneuver to turn a fetus in the uterus.
Think about why a fetus would need to be turned. The most common reason is a non-cephalic presentation, like breech.
Evaluate each option:
Anencephaly and hydrocephalus are structural defects, not positional problems.
Breech presentation is a positional problem where the fetus is not head-down.

Concept Tested & Keywords

Concept Tested: Management of Fetal Malpresentation using External Cephalic Version (ECV)
Stem keywords: external cephalic version, manage
Lead-in keywords: commonly used to