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External and Internal Version or Procedures during Pregnancy

Version is the term for the procedures used to turn a fetus from the transverse-or breech-presentation into a vertex-or head-down­ presentation. External version is done during the last weeks of pregnancy . Internal version is performed through the uterus after the membranes have ruptured. In obstetrics today, internal version is reserved for delivery of a second twin, and even then is performed infrequently.

Internal version is correctly termed internal podalic version(Greek: pous = foot) because the obstetrician inserts a hand into the uterus and grasps the fetus by one or both feet to turn the baby-usually from a transverse presentation into a footling breech. While the baby’s feet are grasped, the upper body is turned through the abdomen. The fetus is then delivered by breech extraction.

Internal version was used in antiquity, lost for intervening centuries, and reintroduced in 1550, prior to the development of forceps. At that time, if labor was obstructed, the only way to extract the baby without using hooks was pulling it out by its feet. Cesareans were not done because mothers were not expected to survive major surgery.

Internal version should be done only by those experienced in its performance. Nowadays, the indication for it is the extraction of a second twin, soon after the birth of the first child, when this twin is not in a breech or vertex presentation. If a second twin presents in a transverse lie, internal s version ordinarily is not difficult. The uterus is relaxed since the first twin has recently been delivered. Twins are usually smaller than other term babies and the foot or feet are readily grasped. The mother must be given appropriate anesthesia, but profound general anesthesia usually is not needed.


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