External Cephalic Version

[Lesassier]

Is it reasonable that family medicine residents could possibly gain training in this without additional training (fellowship or otherwise), provided their program has strong Ob?

Has anyone witnessed or does anyone have experience with acupuncture/moxibustion use for turning a breech presentation?

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[reedman]

i hope not

 

[hippiedoc13]

Has anyone witnessed or does anyone have experience with acupuncture/moxibustion use for turning a breech presentation?

To be honest, most of my experience with this has involved trying very hard to keep a straight face and remain tolerant and non-judgmental when OB patients start talking about this crap.

 

[Lesassier]

To be honest, most of my experience with this has involved trying very hard to keep a straight face and remain tolerant and non-judgmental when OB patients start talking about this crap.

This was a point of curiosity that came up as I read on ECV, and I only looked through one meta-analysis done on studies (mostly European) that showed general favorability although cautioned due to the high heterogeneity. But thanks for almost being tolerant of me talking about this crap... 🙂

My primary interest was really more for ECV as I have wondered why it is so underutilized? I can speculate from a more cynical perspective but other reasons seem to be escaping me.

 

[kelaskov]

I'm a FP resident training at an ob heavy program. We are taught ECV and work closely with the Ob department. It makes sense to me that anyone routinely delivering babies would learn this helpful technique.

I'm not familiar with the use of acupuncture to turn babies..I don't think anyone in our department or the ob department uses it. Never heard of it actually. How is it supposed to work?

 

[sia_simba]

First off all, ECV is dangerous and only certain individuals do it. If you are in FP and getting taught this technique, I have to give it to you and the program.

I have done maybe about 3 of these and seen 2 done. There are many criteria that needs to be met before it. Everyone reads the textbook and see it as an alternative for Breech delivery, but it depends on where you practice... how many physicians allow breech deliveries? let alone ECV.

If you are a FP physician, I would strongly recommend doing normal deliveries. If you want to attempt ECV, make sure you have an ob/gyn and OR ready.

To answer the original poster's question... you can try to learn whatever you want as long as the institution allows for it. However, like forcep deliveries, ECV is not performed as frequent. I wouldn't be too worry about it. Just do your FP training and if need be, do a fellowship in obstetrics.

If you are really crazy about doing ECV, do an ob/gyn residency.

 

[kelaskov]

This article is from Lancaster. I'm assuming they train their FP residents to do ECM when the conditions are favorable.

http://www.aafp.org/afp/980901ap/coco.html

Going by the article above, it seems to have a relatively high degree of success and can spare women major abdominal surgery. ECV is not done in my hospital without a readily available OR.

Here are some other abstracts per pubmed:

http://www.ncbi.nlm.nih.gov/pubmed/18978117

http://www.ncbi.nlm.nih.gov/pubmed/16437421

Sai- do you have data to show that ECV is more risky, on average, than doing a c/section or vacuum/forcepts delivery (hopefully data that includes comparisons on on maternal morbidity outcomes as well.)

 

[Lesassier]

If you are a FP physician, I would strongly recommend doing normal deliveries. If you want to attempt ECV, make sure you have an ob/gyn and OR ready.

To answer the original poster's question... you can try to learn whatever you want as long as the institution allows for it. However, like forcep deliveries, ECV is not performed as frequent. I wouldn't be too worry about it. Just do your FP training and if need be, do a fellowship in obstetrics.

If you are really crazy about doing ECV, do an ob/gyn residency.

I take it you are not an FM resident. I'm wondering if you feel the same way about FM docs who have c-section training and privileges. Are they too not qualified to do ECV? My understanding was that ECV, while it does carry risk, has a very low complication rate. I was not suggesting it be done outside a hospital where it could go to C-section immediately, or done without a fetal heart rate monitor or ultrasound.

My question was not about fellowship. I am aware of at least one family program that advertises that its residents do ECV, as well as forceps/device assisted all during regular 3 year training, not with fellowship. Of course that program also seems to have their residents log >50 or so C-sections. Other programs advertise similar C-section numbers and again my understanding is that its not impossible for a resident to log 50+ as the primary surgeon at many programs. However, I have not seen those same programs discuss ECV.

I do not want to do an Ob/Gyn residency. And I understand that this is not something that would get me privileges at an NYC hospital.

 

[sia_simba]

Yes, I am an OB/GYN resident.

I am not saying that FP residents/attendings should NOT do any obstetrics because they are less qualified but simply that ECV should NOT be why you want to do some obstetrics. If you do plan to do ECV... you should have an OR ready. I mean... quite honestly... as a FP attending how many cesareans do you really do in comparison to someone who is doing mainly OB/GYN ?

Just a comparison, from incision to getting the baby out, it takes from 1 to 2 mins by a good 3rd year ob/gyn resident. less than 1 minute for some of the veteran Attendings at my facility. Besides, obstetric surgical, we are also trained in gynecologic surgeries... which means we are very use to performing surgeries daily.

Its pretty much a numbers game, the more you do it, the better you are at it.

Ceasrean has its risks in terms of surgery and post-op.
We hardly use forcepts delivery anymore
When you do ECV, its continuous EFM, it is NOT always successful, and you have the risk of performing a stat cesarean. also risk of uterine and/or placenta abruption.

In my honest opinion, I rather perform a scheduled cesarean than a stat cesarean.

So the answer in my opinion is "YES"... in a FP program, you can do ECV. You DO NOT need to do a separate fellowship training, however, it is how comfortable the physician teaching you are, and how comfortable you will be.

Goodluck!