EXTERNAL CEPHALIC VERSION AFTER PREVIOUS CESAREAN-SECTION - A CLINICAL DILEMMA

OBJECTIVES: To describe our limited experience with external cephalic version from breech to vertex presentation at term, with the use of ri todrine tocolysis, in women who had undergone a previous cesarean deli very. METHODS: Eleven parturients after previous cesarean delivery und erwent external version after 36 gestational weeks, utilizing tocolysi s with ritodrine, after excluding cases of low-lying placenta, severe oligohydramnion or ruptured membranes. Patients were then followed unt il delivery and scar examination was carried out after vaginal deliver y, or at re-cesarean section, according to mode of delivery. RESULTS: All 11 attempted versions were successful. Six patients subsequently d elivered vaginally and five by re-cesarean section. None of the uterin e scars showed any signs of dehiscence. Three of the five infants deli vered by re-cesarean section weighed over 4000 g, whereas all of the v aginally-delivered infants weighed under 3500 g. CONCLUSIONS: External cephalic version to vertex presentation after previous cesarean secti on was successful in all 11 carefully, selected patients. No untoward effects were noted, and no signs of scar dehiscence were found. The sa fety and efficacy of this procedure after previous cesarean delivery s hould be examined further.