Interventions for helping to turn term breech babies to head first presentation when using external cephalic version

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Evidence-Based Medicine

Background:

• Breech presentation at term is associated with increased obstetric complications.
• External cephalic version (ECV) aims to convert breech presentation to cephalic.
• Various interventions are explored to improve ECV success rates.

Purpose of the Study:

• To evaluate the effectiveness of interventions like tocolysis, regional analgesia, and others in facilitating ECV.
• To assess the impact of these interventions on successful version, birth presentation, mode of delivery, and maternal/perinatal outcomes.

Main Methods:

• Systematic review of randomized and quasi-randomized controlled trials.
• Searched Cochrane Pregnancy and Childbirth Group's Trials Register and reference lists.
• Included 28 studies with data from 2786 women.

Main Results:

• Parenteral beta stimulants increased cephalic presentation in labor (low-quality evidence) and reduced cesarean sections (moderate-quality evidence).
• Beta stimulants also reduced failure of ECV (moderate-quality evidence).
• Regional analgesia combined with tocolysis improved successful version rates compared to tocolysis alone (moderate-quality evidence); insufficient data for other outcomes.

Conclusions:

• Parenteral beta stimulants are effective for ECV but require more data on adverse effects.
• Evidence for other tocolytic drugs, regional analgesia without tocolysis, and other interventions is insufficient.
• Further research is needed to clarify the role of various adjuncts and standardize ECV techniques.