Ritodrine versus salbutamol for external cephalic version.

BACKGROUND: Treatment with beta-agonist tocolytics preceding external cephalic version (ECV) attempt increases success rates. Most studies have focused on intravenously and orally administered beta-agonists, while other administration routes including intramuscularly (IM) and subcutaneously (SC) are understudied. The aim of this study was to compare the efficacy of IM ritodrine to SC salbutamol given prior to ECV. METHODS: A retrospective study of patients who underwent ECV between 1/2012 and 12/2019 at two medical centers. We compared patients undergoing ECV following IM ritodrine versus SC salbutamol. We matched the two groups by parity and placental location. Maternal, pregnancy, ECV procedure and neonatal characteristics were compared. RESULTS: Overall, 601 women were included in each group. Median maternal age and amniotic fluid index (AFI) were lower in the Ritodrine group (27 vs. 32 years, P<0.001, 11 vs. 15 AFI cm, P<0.001, respectively). The median gestational age at ECV was higher in the Ritodrine group (380/7 vs. 370/7 weeks gestation). Success rate was higher in the Ritodrine group (71.7% vs. 63.8%, P=0.003). Vaginal delivery rate was higher in the Ritodrine group (70.7% vs. 60.1%, P<0.001). The number needed to treat to benefit was 10. In a multivariate analysis, Ritodrine was independently associated with higher ECV success rates as compared with Salbutamol (aOR 2.1, 95%CI 1.52-2.89). CONCLUSIONS: Intramuscular ritodrine significantly improved the success rate of ECV compared to SC salbutamol, and both drugs were safe and acceptable before ECV.

Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review.

BACKGROUND: The success rates of external cephalic version (ECV) are improved with the use of betamimetic tocolytics, but these drugs are associated with maternal side effects. OBJECTIVES: To critically evaluate the effectiveness and advantages, if any, of nifedipine as a tocolytic for ECV. SEARCH STRATEGY: We searched PubMed, OVID [Medline, all evidence-based medicine (EBM) reviews], Embase, the Cochrane clinical trials register and references therein. SELECTION CRITERIA: Randomised trials comparing nifedipine with placebo or another tocolytic agent among women with a singleton, term breech or transverse presentation. DATA COLLECTION AND ANALYSIS: Two reviewers evaluated search results and extracted data from eligible studies using a standard data extraction form. Primary outcomes were success rates of ECV and cephalic presentation at delivery. Pooled relative risks and 95% confidence intervals were calculated for comparable studies, and where similar outcomes were assessed. MAIN RESULTS: Three trials met the inclusion criteria. Two trials (n = 176) compared nifedipine with terbutaline and found lower rates of successful ECV among women receiving nifedipine, pooled risk ratio = 0.67 (95% CI 0.48-0.93, P = 0.016). One trial (n = 320) comparing nifedipine with placebo did not find any significant difference in ECV success rates (41.6% nifedipine versus 37.2% placebo, P = 0.43). Although minor side effects were slightly higher with nifedipine compared with placebo, there was no significant difference in the rate of adverse maternal or neonatal outcomes or maternal satisfaction between the nifedipine and terbutaline groups, and women in both groups showed a similar preference for oral administration (62% nifedipine and 71% terbutaline). AUTHORS' CONCLUSIONS: This review found no evidence to support the use of nifedipine for tocolysis to facilitate external cephalic version.

Intravenous salbutamol for external cephalic version.

OBJECTIVE: To evaluate the success of external cephalic version (ECV) using an adjusted bolus dose of intravenous salbutamol compared with no tocolysis. METHODS: An open-label randomized study of 114 women with a term breech fetus randomized to receive either an intravenous bolus dose of 0.1 mg salbutamol with further boluses every 5 minutes, as required, before commencing ECV, or no tocolysis. Primary outcomes were successful ECV and rate of cesarean delivery. RESULTS: Salbutamol tocolysis resulted in a higher rate of successful ECV compared with no tocolysis (70.2% [40/57] vs 36.8% [21/57]; RR 1.9, 95% CI 1.3-2.8; P<0.001). Cesarean delivery rate was lower in the salbutamol group compared with the control group (31.6% [18/57] vs 63.2% [36/57]; RR 0.5, 95% CI 0.3-0.8; P=0.001). Salbutamol dose ranged from 0.1-0.4 mg and outcome was not related to dose. CONCLUSION: Adjusted dose intravenous salbutamol tocolysis prior to ECV increases its success rate and reduces the cesarean delivery rate.

Oral nifepidine versus subcutaneous terbutaline tocolysis for external cephalic version: a double-blind randomised trial.

OBJECTIVE: To evaluate oral nifedipine versus subcutaneous terbutaline tocolysis for external cephalic version (ECV). DESIGN: A double-blind randomised trial. SETTING: A university hospital in Malaysia. POPULATION: Non-labouring women with a term singleton fetus in breech presentation or transverse lie suitable for elective ECV. METHODS: Participants were randomised to either 10 mg oral nifedipine tablet and subcutaneous saline placebo or oral placebo tablet and 250 microgram bolus terbutaline subcutaneously. Participants and providers were blinded. Ultrasound assessment and cardiotocogram were performed prior to ECV. ECV was commenced 20-30 minutes after treatment. A maximum of two ECV attempts were permitted. Elective caesarean delivery or a repeat ECV attempt at a later date was offered to participants following failed ECV. After successful ECV, management was expectant. MAIN OUTCOME MEASURES: Primary outcomes were successful ECV (cephalic presentation immediately after ECV) and caesarean delivery. RESULTS: Ninety women were randomised: 44 to nifedipine and 46 to terbutaline. Initial ECV success rate was 15/44 (34.1%) versus 24/46 (52.2%) (relative risk [RR] 0.7, 95% CI 0.4-1.1; P= 0.094), and caesarean delivery rate was 34/44 (77.3%) versus 26/46 (56.5%) (RR 1.4, 95% CI 1.01-1.85; numbers needed to treat to benefit 5, 95% CI 2.5-55; P= 0.046) for nifedipine and terbutaline groups, respectively. Neonatal outcome was not different. CONCLUSIONS: Bolus subcutaneous terbutaline tocolysis for ECV compared with oral nifedipine resulted in less caesarean deliveries. ECV success rate was not significantly higher. Larger studies are indicated.

Nifedipine versus terbutaline for tocolysis in external cephalic version.

OBJECTIVE: To study the efficacy of nifedipine compared with terbutaline as a tocolytic agent in external cephalic version (ECV). METHODS: A prospective, randomized, comparative trial was carried out in a tertiary hospital. Women with singleton term breech pregnancies were randomized for nifedipine (group A) and terbutaline (group B) tocolysis for ECV in an outpatient setting. The efficacy, side effects, and complications were analyzed and compared. RESULTS: A total of 86 women were recruited with 43 women in each group. The overall success rate was 48.8% and this reduced the rate of cesarean delivery for breech presentation by 32.5% in our center. ECV was successful in 39.5% of women in group A and 58.1% in group B. Fewer side effects were experienced by the women in group A compared with group B, although this was not significant. CONCLUSION: Nifedipine can be used as an alternative for tocolysis in ECV when there are maternal contraindications to beta-sympathomimetics.