1. VERSION
Fahad zakwan

2. Definition:
• It is changing the transverse lie to a longitudinal one
or replacement the presenting pole by the other.
• If the aim is to make the head the presenting part it is
called cephalic version
• if the breech will be the presenting part it is podalic
version.

3. Types:
•External version, usually cephalic.
•Internal podalic version.
•Bipolar podalic version.

4. External Cephalic Version
Indications:
•Breech presentation.
•Transverse or oblique lie.

5. •Procedure:
•No anaesthesia as the pain is a safe guard
against rough manipulations.
•The patient evacuates her bladder.
•She lies in a trendelenburg position with
exposed vulva to detect any vaginal
bleeding.

6. • The foetal position is determined and FHS is auscultated.
• One hand is applied externally to the foetal head and the other 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.
• The FHS is auscultated again, if there is foetal distress lasting for more
than 5 minutes, the foetus 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 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.

7. INTERNAL PODALIC VERSION
Indications:
•Retained second twin in a
transverse lie.
•Some cases of shoulder
presentation.

8. Prerequisites:
•General anaesthesia to guard
against pain and give uterine and
pelvic relaxation.
•Evacuation of the bladder.
•Complete aseptic conditions

9. •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 foetal as
hydrocephalus.

10. Procedure:
• Lithotomy position.
• Episiotomy in primigravida.
• The hand is introduced through the cervix into the uterus and 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 brought
downwards.
• The other foot is brought down and breech extraction is done.
• The birth canal is explored after delivery for possible injuries.

11. Complications:
(A) Maternal :
• Shock ( in light anaesthesia) .
• Premature separation of the placenta.
• Rupture uterus.
• Cervical lacerations.
• Postpartum haemorrhage.
• Puerperal sepsis.

12. (B) Foetal:
•Asphyxia due to premature
separation of the placenta or
entangling of the cord.
•Complications of breech delivery.