Version

A version is a specific form or variant of something, distinguished from earlier or later forms by changes, updates, or differences.

Common uses:

Software/Technology A numbered release of a program or system that reflects updates, bug fixes, or new features (e.g., "version 2.0"). Higher numbers typically indicate newer iterations.

General meaning A particular form of something that differs from other forms of the same thing - such as a translated version of a book, a director's cut of a film, or a revised edition of a document.

Versioning systems typically use formats like:

Major.Minor.Patch (e.g., 3.1.4) - where major = breaking changes, minor = new features, patch = small fixes
Date-based (e.g., 2026.06) - used by some software to indicate release date
Named releases (e.g., "Orion", "Bionic Beaver")

Etymology

From Latin versio ("a turning"), from vertere ("to turn") - the idea of something being "turned" or transformed into a new form.

Version in obg

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Version in Obstetrics & Gynecology

Version is a obstetric procedure in which the fetus is manually turned from a malpresentation (breech or transverse lie) into a more favorable presentation - almost always cephalic (vertex/head-down) - to facilitate vaginal delivery or reduce the need for cesarean section.

There are two main types:

1. External Cephalic Version (ECV)

The most commonly performed type. The fetus is manipulated entirely from outside through the maternal abdomen.

Timing

Performed at 36 weeks' gestation (not before, to avoid preterm birth; not too late, to maximize success before engagement).

Success Rate

Approximately 65% at 36 weeks. Success rate for transverse lie approaches 90%.

Technique

Figure: External cephalic version using the classic forward roll. A: Breech is mobilized. B & C: Breech pushed upward while the head is directed into the pelvis.

Confirm breech presentation by real-time ultrasound; rule out oligohydramnios, multiple gestation, fetal anomalies
Perform a reactive non-stress test (NST)
Administer a tocolytic (terbutaline 0.25 mg SC) to relax the uterus
Apply mineral oil to the abdomen to facilitate hand movement
One operator elevates/displaces the breech; a second guides the head in the opposite direction
Attempt a forward roll first; if unsuccessful, try a backward roll
Monitor fetal heart rate with Doppler throughout; continue external monitoring for 1 hour post-procedure
Administer RhoGAM to Rh-negative mothers

Note: A common error is attempting to turn the fetus before mobilizing the breech out of the pelvis.

Pre-procedure Equipment Needed

Fetal heart rate monitor
Ultrasound machine
Examination table (Trendelenburg capable)
Tocolytic agent
RhoGAM (for Rh-negative patients)

2. Internal Podalic Version (IPV)

The operator inserts a hand into the uterus, grasps one or both fetal feet, and turns the fetus to a breech presentation for delivery. This is now rarely performed and mainly reserved for:

Delivery of a non-vertex second twin
Certain emergency situations

Factors Predicting Success vs. Failure

Favorable (Success)	Unfavorable (Failure)
Multiparity (most consistent)	Engaged presenting part*
Adequate amniotic fluid (higher AFI = higher success)	Difficulty palpating fetal head*
Transverse lie (up to 90% success)	Uterus tense to palpation*
Unengaged fetal part	Maternal obesity
Earlier gestational age at attempt	Anterior placenta
	Cervical dilation
	Decreased AFI

*If all three asterisked factors are present, success rate is essentially 0%. If none are present, success exceeds 90%.

Contraindications to ECV

Uterine anomalies
Third-trimester bleeding
Multiple gestation
Oligohydramnios
Evidence of uteroplacental insufficiency
Nuchal cord identified on ultrasound
Previous cesarean delivery or significant uterine surgery
Obvious cephalopelvic disproportion (CPD)

Outcomes & Complications

ECV reduces the risk of cesarean delivery by ~50% in patients with breech presentation at 36 weeks
Serious complications (placental separation, cord compression requiring immediate delivery) occur in 1-2%
Transient fetal bradycardia occurs in ~20% of attempts but almost always resolves when manipulation ceases
Spontaneous reversion to breech after successful ECV: ~7%
Even after successful ECV, patients have higher rates of instrumental and emergency cesarean delivery compared to primary vertex presentations

Sources: Creasy & Resnik's Maternal-Fetal Medicine, Pfenninger and Fowler's Procedures for Primary Care, Miller's Anesthesia, 10e

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