Nifedipine as a Uterine Relaxant for External Cephalic Version: A Randomized Controlled Trial

Kok, Marjolein; Bais, Joke; Lith, Jan M. van; Papatsonis, D. M.; Kleiverda, Gunilla; Hanny, D.; Doornbos, Johannes P.R.; Mol, Ben Willem J.; Post, J.A. van der

doi:10.1097/01.aoa.0000350631.65172.89

Cited by 10 publications

(34 citation statements)

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“…Characteristics of the three randomised controlled trials are presented in Table 1. Two of these studies were double blinded, 13,14 two compared nifedipine with terbutaline, 13,15 and one compared nifedipine with placebo 14 . Randomisation and allocation concealment were adequate in the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Two trials were conducted at teaching hospitals in Malaysia, 13,15 and the third trial was performed in seven teaching hospitals in the Netherlands 14 . Collaris and Tan 13 included women with a fetus in either breech presentation or transverse lie, whereas the other two trials only included women with a breech fetus.…”

Section: Resultsmentioning

confidence: 99%

“…Kok et al. 14 specifically excluded women who had previously undergone ECV. Collaris and Tan 13 re‐enrolled seven women undergoing a second attempt at ECV (following an initial unsuccessful attempt); however, these women were excluded from the primary outcome analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Collaris and Tan 13 re‐enrolled seven women undergoing a second attempt at ECV (following an initial unsuccessful attempt); however, these women were excluded from the primary outcome analysis. All three trials included both nulliparous and multiparous women, and the distribution was similar in both arms of the trial 13–15 …”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review

Wilcox

Nassar

Roberts

2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Background The success rates of external cephalic version (ECV) are improved with the use of betamimetic tocolytics, but these drugs are associated with maternal side effects.Objectives To critically evaluate the effectiveness and advantages, if any, of nifedipine as a tocolytic for ECV.Search strategy We searched PubMed, OVID [Medline, all evidence-based medicine (EBM) reviews], Embase, the Cochrane clinical trials register and references therein.Selection criteria Randomised trials comparing nifedipine with placebo or another tocolytic agent among women with a singleton, term breech or transverse presentation.Data collection and analysis Two reviewers evaluated search results and extracted data from eligible studies using a standard data extraction form. Primary outcomes were success rates of ECV and cephalic presentation at delivery. Pooled relative risks and 95% confidence intervals were calculated for comparable studies, and where similar outcomes were assessed.Main results Three trials met the inclusion criteria. Two trials (n = 176) compared nifedipine with terbutaline and found lower rates of successful ECV among women receiving nifedipine, pooled risk ratio = 0.67 (95% CI 0.48-0.93, P = 0.016). One trial (n = 320) comparing nifedipine with placebo did not find any significant difference in ECV success rates (41.6% nifedipine versus 37.2% placebo, P = 0.43). Although minor side effects were slightly higher with nifedipine compared with placebo, there was no significant difference in the rate of adverse maternal or neonatal outcomes or maternal satisfaction between the nifedipine and terbutaline groups, and women in both groups showed a similar preference for oral administration (62% nifedipine and 71% terbutaline).Authors' conclusions This review found no evidence to support the use of nifedipine for tocolysis to facilitate external cephalic version.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review

Wilcox

Nassar

Roberts

2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…In a randomized, double-blind, placebocontrolled trial of 320 participants, nifedipine did not significantly improve the success of ECV (22 ECV, there was a higher ECV rate with terbutaline (52.2-58.1% for terbutaline vs. 34.1-39.5% for nifedipine), less cesarean sections, no difference in neonatal outcomes, although more side effects (maternal palpitations and tachycardia) (23)(24)(25). Fetal acoustic stimulation.…”

Section: Workupmentioning

confidence: 98%

Malpresentation and malposition

Tong¹

2012

Obstetric Evidence Based Guidelines

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l Malpresentation is associated with uterine anomalies, fibroids, placenta previa, grand multiparity, contracted maternal pelvis, pelvic tumors, prematurity (the earlier the gestational age, the higher the incidence of malpresentation), multiple gestation, polyhydramnios, short umbilical cord, fetal anomalies (e.g., anencephaly, hydrocephalus), abnormal fetal motor ability, and prior breech delivery. l Complications of breech presentation are congenital anomalies, preterm birth (PTB), birth trauma, low Apgar scores, and lower pH, mostly regardless of mode of delivery. Cord prolapse, head hyperextension, and head or arm entrapment are more common with vaginal breech delivery. l External cephalic version (ECV) is a safe and effective intervention. Urgent cesarean delivery (CD) for nonreassuring fetal heart rate tracing (NRFHT) and placental abruption occur in <0.5% of ECV. l ECV is avoided with any contraindications to vaginal delivery such as placenta previa, or prior classical uterine incision, and, relatively, with rupture of membranes, oligohydramnios, known uterine or fetal anomaly, unexplained uterine bleeding, or active phase of labor. l ECV reduces the incidences of noncephalic birth by 54% and CD by 37%. Because ECV is associated with a very low incidence of adverse events and with a significant decrease in CD, all women at or near term with nonvertex presentations should be offered an ECV attempt. Success rates range roughly average 50% to 70%. Success is increased with higher parity, transverse or oblique lie, nonengagement of the breech, a relaxed uterus, a palpable fetal head, and maternal weight less than 65 kg. l There is insufficient evidence to assess the best gestational age at which to perform ECV. Compared with ECV at term, ECV before term (e.g., 34-35 weeks) reduces noncephalic presentation at birth but does not reduce the rate of CD, and may be associated with an increase in the incidence of PTB. About 36 weeks is generally considered to be the optimal time for attempted version.l Tocolysis with betamimetics prior to attempt at ECV is associated with fewer failures of ECV, and less CDs. l Anesthetic dose neuraxial blockade (usually with spinal) is associated with a 44% increase in the success rate of external fetal version. l ECV should be performed in a facility with ready availability for emergency CD, after appropriate counseling and consent, with ultrasound availability. l

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Clinical outcomes after external cephalic version with spinal anesthesia after failure of a first attempt without anesthesia

Massalha

Garmi

Zafran

et al. 2017

Intl J Gynecology & Obste

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Nifedipine as a Uterine Relaxant for External Cephalic Version: A Randomized Controlled Trial

Cited by 10 publications

References 0 publications

Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review

Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review

Malpresentation and malposition

Clinical outcomes after external cephalic version with spinal anesthesia after failure of a first attempt without anesthesia

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