Atosiban versus ritodrine as tocolytics in external cephalic version

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Perinatal Medicine

Background:

• External cephalic version (ECV) is a procedure to convert breech presentation to cephalic before labor.
• Tocolytic agents are used to suppress uterine contractions during ECV.
• Atosiban and ritodrine are commonly used tocolytics, but their comparative efficacy in ECV is not fully established.

Purpose of the Study:

• To compare the efficacy of atosiban versus ritodrine as tocolytic agents in external cephalic version (ECV).
• To evaluate complications and perinatal outcomes associated with each tocolytic agent during ECV.

Main Methods:

• A prospective comparative trial involving 430 women with singleton breech pregnancies at ≥36 weeks gestation.
• Participants received either ritodrine (n=215) or atosiban (n=215) as tocolytic agents prior to ECV.
• Efficacy, complications, and perinatal outcomes were analyzed using statistical tests (chi-square, t-test, Mann-Whitney).

Main Results:

• The overall ECV success rate was 47.9%, with no significant difference between the atosiban (46.0%) and ritodrine (49.8%) groups (p=0.440).
• A higher incidence of uterine contractions post-maneuver was noted in the atosiban group (34.4% vs 22.8%), though without clinical significance (p=0.008).
• Perinatal outcomes were comparable between the two groups, with no statistically significant differences observed.

Conclusions:

• Atosiban and ritodrine exhibit similar efficacy as tocolytic agents for external cephalic version.
• No significant differences in complications or perinatal outcomes were found between atosiban and ritodrine in this ECV trial.