Randomized control trial of external cephalic version with tocolysis in late pregnancy

External cephalic version: a clinical experience

“…External manipulation of the fetus can convert 60 -90% of breech presentations to cephalic depending upon technique, the skill of the operator, use of tocolysis, and the population selected for trial [6,7,9,13,14,16,18,20,21].…”

“…However, we soon discovered that betamimetic assisted version was easier for both patient and operator, and thereafter, we administered tocolytics routinely (overall in 43/85 or 50.5%). Betamimetics are not without serious complications, but neither we nor others have observed complications from acute administration for ECV [6,14,18]. Terbutaline was chosen because of our successful prior experience with this agent; the route of administration by convenience and economy.…”

“…However, the risks of vaginal breech delivery can be avoided if the fetus is manipulated from breech to cephalic presentation by external cephalic version (ECV) [6,9,13,14,16,17,18,20,21]. Randomized prospective studies have indicated that 3rd trimester ECV performed with tocolysis following real time ultrasound and cardiotocography screening, involves minimal fetal risk and is 60-90% successful [9,18]. As the role for late third trimester ECV is not established in pregnancies with breech presentation, we initiated a prospective clinical trial of ECV to evaluate the safety and utility of the procedure.…”

External cephalic version in breech presentations at term: comparison of maternal and perinatal outcome with normal pregnancies

“…There were higher success rates in studies by Van Dorsten et al (68%) and Morrison et al (68%) using tocolytics. 9,10 No inhalational or regional anaesthesia was used in our study to facilitate version. The success rates by Schorr et al and Carlan et al were 51% and 59% respectively using epidural anaesthesia with 2% lidocaine and terbutaline for tocolysis.…”

External Cephalic Version

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Se sabe que hay un incremento en la morbimortalidad perinatal de los productos de un parto vaginal en podálica, aun excluyendo los que tienen malformaciones congénitas asociadas, lo que es frecuente; además, el seguimiento a largo plazo ha mostrado mayor incidencia de dario neurológico no detectado en el período perinatal y que depende más del tipo de parto que de la presentación como tal (3,6,9,12).Está ampliamente demostrado que el resultado de la presentación podálica atendida por cesárea es comparable al del parto vaginal en vértice; sin embargo, es un procedimiento con riesgos y complicaciones (4,6). En un estudio local reciente de 33 muertes maternas que tuvieron como causa directa o indirecta un evento obstétrico se concluyó que "las mujeres sometidas a cesárea tienen una probabilidad de muerte materna cuatro veces mayor que la de aquéllas que no sufrieron tal procedimiento" (3).

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