external inversion

External reversal is obstetric breech surgery. The breech position accounts for about 3% to 4% of the total number of births. The incidence of premature delivery, premature rupture of membranes and umbilical cord prolapse in breech delivery is high, and it is easy to cause asphyxia and birth injury. The perinatal mortality rate of vaginal delivery is about 10 times higher than that of the first child. The hazard of the breech to the mother is caused by complications such as birth injury, bleeding and infection. Therefore, we should actively reduce the yield of the gluteal, rationally choose the mode of delivery, and improve the delivery technology. More than half of the breech found at 30 weeks of gestation can be converted to a head position. Natural rotation occurs mostly before 34 weeks, and the possibility of rotation after 37 weeks is small. External reversal is one of the methods to correct the breech position, but there is a certain risk, occasionally premature delivery, premature rupture of membranes, early exfoliation of the placenta and fetal death. Some people think that the success rate of external surgery is 36-37 weeks, and the complications are low. In the event of problems such as placental abruption or umbilical cord entanglement, cesarean section can be performed immediately, and too early and externally reversed surgery is prone to premature birth and is not necessary. Curing disease: Indication External reversal is applicable to: 32 to 40 weeks of single breech position, which is corrected by changing the body potential or other methods. Contraindications 1, external reversal surgery may endanger the fetus, such as threatened premature delivery, intrauterine distress, uterine bleeding, intrauterine growth retardation and overdue pregnancy. 2, external reversal surgery may endanger the mother or cause placental abruption, such as heart disease, moderate to severe pregnancy-induced hypertension syndrome, diabetes, chronic nephritis, chronic hypertension and bleeding tendency. 3, affecting the effect of external reversal, and easy to cause complications, such as oligohydramnios, umbilical cord entanglement, fetal head extension, uterine malformation and uterine anterior wall placenta. 4, no need to reverse the situation, such as the obvious head basin is not called (including pelvic stenosis and fetal oversize) and placenta previa. 5, uterine scars should not be used. Preoperative preparation 1, blood pressure, urine protein, urine sugar, blood routine, platelets. 2, B type super check 1 breech classification (genuine single hip, full hip, not full hip); 2 hip orientation ( left, right front, left, right back or left, right horizontal); 3 fetal line Estimate fetal weight; 4 placental position; 5 with or without umbilical cord around the neck; 6 amniotic fluid volume; 7 fetal malformations. 3, conditional care for fetal heart monitoring, NST is reactive. 4, 0.5 ~ 1h before surgery, taking 4.8mg of salbutamol sulfate or 0.5h before the subcutaneous injection of 0.25 mg of hydroxy salbutamol. Surgical procedure 1, emptying the bladder, lying on the back, hips high, legs flexed, slightly outreach. Use a four-step diagnosis to check the height of the fundus, the position of the fetal head, the type of breech, and the height of the first exposure. After the sputum, the pregnant woman is placed in the prone position on the back side of the fetus for 20 minutes, so that the natural transformation into the transverse or anterior position. Some talcum powder can be sprinkled on the abdominal wall. 2. The operator stands on the right side of the pregnant woman, and the two hands hold the fetal hips toward the entrance of the pelvis. The strength of the wrist joint is used to lift the fetal buttocks, and the direction of the humerus is opposite to the side of the head. That is, if the head and the back are on the side of the mother's midline, use Backward Somersault to push the buttocks to the ventral side of the fetus; if the head and back are not on the same side, use Forward Somersault. The hips are pushed to the back of the child. 3, the surgeon pushes the hip in one hand, and the other hand pushes the head to turn in the opposite direction to the hip. Care is taken to keep the head flexed and the carcass bent so that it crosses the uterus. 4, after the head is pushed to the armpit, you can suspend the operation, check the fetus, pay attention to the reaction of the pregnant woman, rest a few minutes and then gently dial the head to complete. If the fetal heart is abnormal in the external rotation, the position can be changed. If the normal position is not restored within 10 minutes, the patient should be transferred back to the original position, or taken to the hospital for observation and treatment. 5, the hips have entered the pelvic entrance, the assistant can wear sterile gloves, after the vulva disinfection will show, the middle finger through the vaginal fistula up to the first exposed part, up and down to promote the hips moved to the pelvic entrance, and then pushed to the armpit , called double reverse (Bimanual Version). 6. Observe for half an hour without abnormality, that is, wrap the abdomen with a multi-head belt or a cotton cloth of 0.3 m×1.2 m, and put the folded face towel on both sides of the head to fix it. Continue to observe for 1h. If there is no internal bleeding, the fetal heart is normal, you can leave. Abdominal pain, bleeding or abnormal fetal movements come to the emergency department. 7, 3d after the re-examination, if the fetal head is still high, you can take a low sitting position to help the basin, and then review once a week, after the fetal head is semi-fixed or fully fixed, you can remove the abdominal band. It is easy to restore the breech position after maternal or amniotic fluid. 8. If the external reversal fails, the pregnant woman can be placed in the knee and chest position twice a day, and then try again after 1 week. The main factors affecting success are the single hip (Frank Breech) and undiscovered uterine malformations. When the leg is stretched, the legs act as a splint, which affects the fetal rotation. At the time of delivery, the fetus is prone to vaginal prolapse, and the birth injury and mortality are lower than the full hip (Complete Breech) and the incomplete hip (Incomplete Breech). ), so you don't have to be reluctant when you have difficulty reversing outside. In addition, less amniotic fluid, first exposed to the basin, short umbilical cord, and anterior wall placenta can affect the effect of external reversal. complication 1, Premature Separation of Placenta (Premature Separation of Placenta) can occur abdominal pain, vaginal bleeding and fetal heart abnormalities, uterine irritability, not relaxed, and tenderness. B-ultrasound can assist with diagnosis. 2, the umbilical cord around the neck or entanglement is mainly characterized by fetal heart abnormalities and difficulty in rotation, the fetal position may be relieved after recovery, severe cases of fetal death. 3, premature rupture of fetal membranes. 4, regular contractions occur after the reversal of premature delivery, the cervix disappears to cause dilatation, vaginal bleeding. 5, uterine rupture mainly occurs in the scar uterus, which is related to improper selection of cases and rough operation.

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