External cephalic version after rupture of membranes in early labor.

BACKGROUND: Breech presentation occurs in approximately 4% of term pregnancies. Recently the American College of Obstetrics and Gynecology has suggested that cesarean section is the safest option if the fetus remains in breech position. As an alternative to cesarean section, external cephalic version has been used prior to labor and even recently in the patient with rupture of membranes not in labor. We present two cases found at our institution from 1990 through 2001, who at term presented in early labor with spontaneous rupture of membranes and underwent successful external cephalic version.

CASE: Two women presented to labor and delivery with spontaneous rupture of membranes and were found to be in early labor with cervical dilatation. Both underwent successful external cephalic version. As labor progressed, each ultimately underwent cesarean section to accomplish delivery. One patient underwent cesarean section for failure to progress and the other for severe variable decelerations associated with an umbilical cord prolapse.

CONCLUSION: External cephalic version is possible in the term pregnancy with ruptured membranes and in early labor, but the patient remains susceptible to complications of version and labor.