Date: _______________
Surgeon: _______________
Assistant(s): _______________
PreOp Dx: Breech presentation, prior vaginal delivery
PostOp Dx: Cephalic presentation, successful version
Operation: External Cephalic Version
Findings: Stable fetal HR pre and post procedure

Clinical Note: Ms. _______________ is a 25 year old G2T1 who presented to L&D for a scheduled external cephalic version. Her past medical history is significant for a previous successful vaginal delivery with no complications. Her current pregnancy has been uncomplicated, however, at her most recent clinical visit it was found that her current gestation is in a breech presentation. Today she is currently 35 weeks and 3 days gestational age. A reactive fetal heart tracing was obtained prior to moving her to the ultrasound suite for the procedure. Risks of ECV, including abnormal fHR, PROM, abruption, injury to fetus, possible emergency C/S, and failed ECV were discussed with the patient and consent was obtained.

Procedure Note: A bedside ultrasound was performed which confirmed the single intrauterine pregnancy and a complete footling breech presentation. There was noted to be adequate fluid (MVP 4.0. AFI 9.2 cm. etc) and a BPP was 8/8. The fetal pelvis was located in the maternal LLQ, spine along the materal left side, and head in the materna RUQ. Using manual pressure, the fetus was manipulated with gentle pressure from the palms against the buttock and posterior occupit to stimulate a forward roll. In total, four attempts where made. Fetal HRs were obtained between each attempt and were reassuring, between 125-135 after each attempt. On the final attempt, the fetus shifted into a vertex lie. Following the procedure, she was noted to have a reassuring and reactive tracing for 1 hour post procedure. She did not have any regular contractions and there were no signs of PROM. She was discharged home with instructions on reasons to return to L&D and otherwise she will follow up in clinic in one week to confirm presentation.