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

Abstract

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.

Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: An overview of systematic reviews

“…This resulted in 169 reports; 159 systematic reviews and 10 practice guidelines. On further review of the 159 systematic reviews, another four were subsequently excluded as two included trials all of which were included in a more recent review [19, 20], and two did not report on any of our pre-specified primary outcomes [21, 22]. This resulted in the inclusion of 155 systematic reviews.…”

External Cephalic Version and Reducing the Incidence of Term Breech Presentation

“…The effect applied to both multiparous and nulliparous women.There is inadequate information comparing different betamimetic drugs on the success rates of ECV. Wilcox et al, in a systematic review of three studies (n = 176), found no evidence to support the use of nifedipine as a tocolytic. There are insufficient data to support the use of nifedipine or atosiban compared with betamimetics .…”

Neuromedin B and Its Receptor Influence the Activity of Myometrial Primary Cells In Vitro Through Regulation of Il6 Expression via the Rela/p65 Pathway in Mice1

“…The global rate of preterm delivery is increasing and there is no effective means of prevention [1]. Current strategies to prolong pregnancy are based on inhibition of uterine myometrium contraction in preterm labor [2][3][4]. However, the mechanism by which spontaneous onset labor is initiated, both at term and preterm, is still unclear.…”