Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double-blinded,...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Trials

Background:

• External cephalic version (ECV) is crucial for reducing term breech presentations and cesarean births.
• Tocolytics may enhance ECV success but their role in repeat attempts is unclear.
• Previous studies have not definitively proven tocolytics alter cesarean section rates.

Purpose of the Study:

• To evaluate the efficacy of tocolysis in repeat external cephalic version (ECV) attempts.
• To determine if tocolysis improves the rate of cephalic presentation at delivery after a failed ECV.
• To assess the impact of tocolysis on cesarean section rates and maternal/neonatal morbidity in repeat ECV.

Main Methods:

• A randomized, double-blinded, placebo-controlled trial was conducted.
• The study included 124 women with breech presentation at term who had a prior unsuccessful ECV.
• Primary outcome was cephalic presentation at delivery; secondary outcomes included cesarean section rates and morbidity.

Main Results:

• Tocolysis significantly increased cephalic presentation incidence (RR 3.21) and decreased cesarean sections (RR 0.33) in repeat ECV.
• The positive effects of tocolysis were most pronounced in multiparous women.
• No significant changes in maternal or neonatal morbidity were observed.

Conclusions:

• Administering tocolysis during repeat ECV attempts improves success rates and lowers cesarean delivery incidence.
• A strategy of using tocolysis only after an initial failed ECV attempt optimizes success with minimal drug use.
• This approach offers a high success rate for achieving cephalic presentation while reducing cesarean births.