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External cephalic version at term: is a tocolytic necessary?

A W Robertson1, J N Kopelman, J A Read

  • 1Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington.

Obstetrics and Gynecology
|December 1, 1987
PubMed
Summary
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This study found that using a beta-mimetic tocolytic drug did not significantly improve the success rate of external cephalic version for breech presentations. Success rates were similar between groups receiving and not receiving the tocolytic agent.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Medicine

Background:

  • External cephalic version (ECV) is a procedure to turn a fetus from a breech to a cephalic presentation.
  • Tocolytic agents are sometimes used to facilitate ECV by relaxing the uterus.

Purpose of the Study:

  • To evaluate the efficacy of a beta-mimetic tocolytic agent in improving the success rate of external cephalic version.
  • To assess maternal and fetal safety associated with tocolytic use during ECV.

Main Methods:

  • Prospective investigation with 58 patients presenting with breech at 37-41 weeks gestation.
  • Random assignment to either a tocolytic (ritodrine hydrochloride) or no-tocolytic group before ECV attempt.
  • Pre- and post-procedure ultrasound, serum alpha-fetoprotein, Kleihauer-Betke test, and nonstress test performed; contraindications included IUGR, oligohydramnios, or nonreactive NST.

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Main Results:

  • Successful version rates were 66.7% in the tocolytic group (20/30) and 67.8% in the no-tocolytic group (19/28), a statistically nonsignificant difference.
  • A second ECV attempt after ritodrine administration in the no-tocolytic group yielded only one success (1/9).
  • No serious maternal or fetal complications were reported in either group.

Conclusions:

  • The use of a beta-mimetic tocolytic agent did not significantly increase the probability of a successful external cephalic version in this patient population.
  • ECV can be performed safely with or without peri-procedural tocolysis.