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

Abstract

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.

Longitudinal ultrasound assessment of fetal presentation: A review of 1010 consecutive cases

“…Obviously, if an aggressive practice of ECV is undertaken the percentages are likely to be halved, particularly in multiparae. 8,9 However, a cephalic presentation at 28-32 weeks results in a 0.85% risk of abnormal presentation in primiparae, and a 0.68% risk in multiparae by 38 weeks.…”

Terbutaline versus salbutamol for suppression of preterm labor: a randomized clinical trial

“…On the other hand, these agents do not decrease the neonatal mortality and morbidity associated with PTL. Thus, the popularity of these agents as first-line tocolytic agents has decreased 1617. Nevertheless, these agents are recommended as first-line tocolytic agents because of their efficacy 1214…”

The use of atosiban and ritodrine in external cephalic version

“…More recent randomised studies confirmed that the administration of ritodrine prior to ECV improved outcome compared to placebo (11), (12). Impey and Pandit, in fact, suggested that atosiban may be a safer alternative compared to ritodrine due to its better side effect profile and as its’ shorter duration of exposure (12).…”