Internal Podalic Version and Breech Extraction

Abstract

Internal podalic version, which was apparently first described by Hippocrates, is a procedure where a series of manoeuvres are performed with one hand inside the uterus, with the aim of bringing one or both feet through a fully dilated cervix. Internal podalic version and breech extraction has also been described as an alternative to emergency caesarean delivery in a multigravid woman with a singleton fetus lying transversely, under exceptional circumstances such as profound bradycardia and there is delay in performing surgery or when the fetus is already dead. The woman should be placed in lithotomy position, cleaned and draped and her bladder should be emptied. Vaginal examination should be performed to be able to ensure full dilatation of cervix. Traction should be applied downwards and backwards in line with the longitudinal axis of the maternal pelvis in order to bring both feet or one foot into the vagina.