Does the use of a tocolytic agent affect the success rate of external cephalic version?

Marquette, Gérald P.; Boucher, Marc; Thériault, Dominique; Rinfret, D.

doi:10.1016/s0002-9378(96)80013-5

Cited by 54 publications

(35 citation statements)

References 7 publications

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“…However, the rate of prolonged decelerations is not reported in all studies [8,9]. Furthermore, the rates differ widely between studies, reflecting the different definitions used [4].…”

Section: Discussionmentioning

confidence: 99%

External Cephalic Version: An Approach with Few Complications

Skupski¹,

Harrison-Restelli²,

Dupont³

2003

Gynecol Obstet Invest

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We performed a retrospective study of all patients referred for external cephalic version (ECV) at ≧36 weeks gestation from 1993 to 2000. Exclusion criteria included ominous fetal heart rate changes, complete or multiple loops of nuchal umbilical cord, extension of the fetal head, oligohydramnios and poorly controlled hypertension. Three groups were compared: spontaneous cephalic version (SCV), ECV attempted (ECV) and ECV not attempted (NoECV). A total of 289 patients were referred. ECV was attempted in 191, 118 by one operator (D.W.S.). ECV was successful in 98/191 (51%) attempts. Spontaneous reversion to breech after successful ECV occurred in 6/98 (6%). There were 4 complications: 1 occult cord prolapse, 2 nonreassuring fetal heart patterns, and 1 placental abruption; all led to nonemergent cesarean delivery (CD). The CD rate (SCV 2/18, 11%; ECV 114/179, 64%; NoECV 49/51, 96%) was highest in the no-attempt group (p = 0.001). The CD rate after successful ECV was 29/91 (32%). Maternal postdelivery complications (SCV 1/16, 6%; ECV 24/161, 15%; NoECV 13/48, 27%) and neonatal complications were not significantly different. With careful attention to contraindications, ECV can be performed with few complications. ECV lowers the CD rate.

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“…However, the rate of prolonged decelerations is not reported in all studies [8,9]. Furthermore, the rates differ widely between studies, reflecting the different definitions used [4].…”

Section: Discussionmentioning

confidence: 99%

External Cephalic Version: An Approach with Few Complications

Skupski¹,

Harrison-Restelli²,

Dupont³

2003

Gynecol Obstet Invest

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“…This is in spite of our points about why ECV could be more difficult in our group of women. The other alternative of using tocolysis only in nulliparous women, as has been advocated by some, 9 could have led to fewer overall successes. This is because the effect of tocolysis seemed most marked in the small group of multiparous women.…”

Section: Discussionmentioning

confidence: 99%

“…7 Tocolysis for all women increases success rates from approximately 40% to 55%. 8,9 Therefore, of the 60 women out of 100 who have had a failed attempt without tocolysis, a further 15 (25%) could reasonably be expected to have a second successful attempt with tocolysis. To detect an increase in the incidence of cephalic presentation from 5% to 25% with 90% power (a ¼ 0.05), 124 patients were required.…”

Section: Methodsmentioning

confidence: 99%

Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double‐blinded, placebo‐controlled trial

Impey

Pandit

2005

BJOG

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Background External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Objective To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt.Design Randomised, double-blinded, placebo-controlled trial.Setting UK teaching hospital.Population One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV. Methods Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat. Main outcome measures Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity. Results The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23 -8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14 -0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64-53.62). Maternal and neonatal morbidity remain unchanged. Conclusions The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis.

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“…Marquette et al ont é galement prouvé l'utilité de la ritodrine en i.v. par rapport au placebo chez les patientes nullipares supé rieures ou é gales à 36 SA [5]. Cette même é quipe a de plus comparé l'utilisation de la nitroglycé rine en SL (deux bouffé es de 400 mg) à celle d'un placebo chez des patientes multipares [6].…”

Section: Discussionunclassified