Combined Internal Cephalic Version

CEPHALIC version is the manipulation by which the presentation is altered to make the head lie over the brim of the pelvis. Most doctors are familiar with external cephalic version. Internal cephalic version is a bipolar version performed by the whole hand inserted through the cervix of the anethetized patient, aided by the other hand on the abdomen and this, to judge by current textbooks , is a manoeuvre which many obstetricians, even the most experienced, ignore. Bipolar is used in its literal sense to indicate a manceuvre performed by pressure on both poles of the foetus, the pressure on the lower pole being exerted by the whole hand and not by two fingers as was implied in earlier times by the use of this terminology and which meaning is still often read into the expression. Kerr and Moir (1949) state, "Internal cephalic version, the operation of Hippocrates, has practically been given up." Stander (1936) writes, "Cephalic version may be accomplished by the combined or bipolar method of Braxton Hicks as soon as the cervix is sufficiently dilated to admit two fingers. It, however, is rarely employed as, in such circumstances, it is usually advisable to wait until the cervix is fully dilated and then to rupture the membranes and do a podalic version followed by extraction." He does not mention a cephalic version, using the whole hand inside the uterus. Few authors are as dogmatic as Eastman (1950): "Cephalic version in modern obstetrics is performed solely by external manipulations." Stern and Burnett (1952) state, "Bipolar version is usually podalic." Referring to internal version they write, "When the cervix is three-fifths or more dilated, the whole hand may be introduced into the uterus. Version is performed by seizing a foot and pulling it down through the cervix, the other hand assisting by abdominal manipulation." Internal cephalic version is not discussed. Strachan (1947) merely defines the manceuvre. Brews (1948), while mentioning that earlier records show that internal version was used to bring down the head, states, "Within recent times it has been employed only as a method of podalic version." Gibberd (1955) completely ignores the possibility of internal cephalic version. Baird (1953) states, "Although originally cephalic version was employed, podalic version is now more common as the foot is much easier to grasp than the head." One feels, however, that internal cephalic version has a definite place in the treatment of …