The version by external company (VME): what is it? How are you? What are the risks?

The expert: Philippe Deruelle, gynecologist and obstetrician

To help the future baby turn upside down, the obstetrician-gynecologist can help with an external maneuver version (VME). What is it made of? What are the risks?

The version by external operation (VME): definition

In the last weeks of pregnancy often in the 36th week of amenorrheato take the baby in the womb a head down position. Sometimes this does not happen spontaneously, in about 3 to 5% of cases. Then there are gentle techniques such as yoga, osteopathy or acupuncture that can work, but with no guarantee of results. Medically, only a gynecologist can help him by performing an external version (VME).

« VME does not take place at home or in a doctor’s office, says Professor Philippe Deruelle, gynecologist and obstetrician. The gesture must be performed in a clinic or hospital in the maternity ward to monitor the mother and baby.. The expectant mother is placed on an examination table and the baby, especially its heart rate, is monitored. An ultrasound is also performed before performing the VME to check its position, but also the position of the placenta and the amount of amniotic fluid present. “We can give to the patient a medicine for infusion to lower uterine tone and prevent possible contractions, says the specialist. Then the baby is pushed through the womb by one or two doctors at the same time, with the goal of bringing his head down and his buttocks up.”.

When should a VME be performed during pregnancy?

According to the obstetrician-gynecologist, “The ideal time for this gesture is between the 35th and 37th week of pregnancyas the baby is not yet taking up all the space and there is enough amniotic fluid to help us”.

What are the disadvantages and risks of a VME?

Sometimes severe pain

“The version by external maneuver reduces births by 50% Caesarean section », reveals Philippe Deruelle. The interest of this gesture is therefore to avoid surgery for the future mother. However, it can be poorly tolerated. “It’s a gesture that can be very painful, I have seen patients cry in pain after VME and manipulation of the baby by the uterus”, he acknowledges.

Possibility of premature birth by caesarean section

However, the gynecologist-obstetrician warns that this gesture always carries a risk, even if it only lasts 5 to 10 minutes.. «Because of this, it must be performed in a medical setting : if it is noted on the ultrasound control, after the procedure that the umbilical cord if the baby strangles or aborts the placenta, the expectant mother will have an emergency caesarean.” Alert the gynecologist-obstetrician.

So the gesture has its advantages and disadvantages: If it works, it saves the expectant mother from having to have an operation to give birth to her child in half the cases. But the other half of the time the VME doesn’t work. In practice we see that the risks are higher with the first child and that VME is easier to perform in a woman with multiple children. “due to the flexibility of the uterus”, Details Professor Deruelle.

Despite release by external maneuver, the fetus can return to its original position

It is also possible that the maneuver will be successful, that the child will turn around again and lower its buttocks. “That is indeed the risk: we can turn the child and then see it return to its starting position, in about one out of two cases. But the most annoying thing is when it causes premature birth, so you have to weigh the pros and cons before doing it to an expectant mother.” recognizes the expert.

Contraindications for external version

In some special cases, it is not possible to perform ELV on a pregnant woman. This is especially true when the expectant mother already had a cesarean section and her uterus has a scar. It is also not possible in the case of a malformation of the uterus, if there is a risk for the future baby or in relation to a problem related to the insertion of the placenta into the uterus.

Can you deliver a baby in complete or decompleted breech presentation?

If the VME does not work or the child returns to the sitting position,Completely (the baby sits cross-legged) or unfinished (the baby has its legs up, feet at head height), the expectant mother can choose to give birth by caesarean section. It will then be scheduled on a specific date at the chosen maternity ward.

However, it is quite possible to attempt a vaginal birth. This occurs in 1% of births, according to the National College of French Obstetrician Gynecologists (CNGOF) website. However, some conditions must be met, because the child is born more or less “folded in two”. The labor of labor must be efficient, with a cervix that opens well to facilitate the exit of the baby, the latter must be of appropriate weight. The mother must also have a fairly wide pelvis to let her child pass in this position. Finally, the seating position can be half-measured and the child can be turned, but not completely, which can make it easier to get out.

Some experienced obstetricians will therefore be able to give birth to you in this way, but retain the option of resorting to an emergency caesarean section if the child’s health requires it.

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