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A randomized, double blind, controlled trial of tocolysis to assist external cephalic version in late pregnancy
1Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Background:
External cephalic version at term is not always successful. This trial was done to ascertain whether tocolysis has any effect on the success rate.
Methods:
A randomized, double blind, controlled trial, with continuous paired sequential analysis. Fifty-one consecutive patients with a singleton fetus in a breech presentation between 36 and 38 weeks gestation, external version being attempted on each. Ritodrine infusion or placebo was infused before attempt at external cephalic version.
Setting:
A university teaching hospital with 8000 confinements annually.
Results:
Version was successful in 17 of the 25 patients given tocolysis, but in only eight of the 25 given placebo (p < 0.01). A positive benefit for tocolysis was shown after version had been completed in 10 pairs of patients. However the trial was continued until 25 pairs had been analyzed. The benefit deteriorated during analysis of the last 15 pairs suggesting that the initial benefit may reflect a learning curve for the procedure.
Conclusion:
Tocolysis is likely to improve the success rate of external cephalic version in late pregnancy, especially in nulliparous mothers or where doctors are learning the technique.