External cephalic version complicated by bradycardia and placental abruption– a case report

Abstract

Introduction:

Pregnancies with the fetus in breech position at term are routinely managed by offering external cephalic version to increase the likelihood of vaginal birth in the cephalic position and reducing the risk of cesarean delivery. Although complications from external cephalic version are infrequent, placental abruption is a rare but serious risk, occurring in 0.08% of attempts.

Methods:

This case report details the experience of a woman with an uncomplicated singleton pregnancy with fetal breech presentation at gestational age 37 weeks and 2 days, coming for an outpatient external cephalic version. Preceding the external cephalic version, a fetal ultrasound and cardiotocography were both normal. Intravenous salbutamol was administered shortly before the procedure.

Results:

The external cephalic version was complicated by a three minute episode of fetal bradycardia, which resolved spontaneously without any maternal symptoms of abdominal pain or vaginal bleeding. Within 35 minutes post-procedure, an ultrasound revealed a de novo placental lake with a jet, potentially coming from a placental artery. The patient also started reporting increasing pain and upon palpation of the abdomen, increased uterine tone was noted. Emergency cesarean was performed resulting in the birth of a healthy girl with normal Apgar scores. Fetal hemoglobin was low at 8.3 mmol/L (reference 9.4 -14.4 mmol/L).

Conclusion:

This case accentuates the importance of caution in women with symptoms of placental abruption such as uterine contractions, increased tone, or vaginal bleeding, especially following a bradycardic event after external cephalic version. While such complications are rare, clinicians should consider a post-procedure fetal ultrasound before discharge in cases where bradycardia is observed.

Funding

None

Trial registration

Not relevant.