External cephalic version at term: is a tocolytic necessary?
This prospective investigation evaluates the benefit of a beta-mimetic tocolytic for external cephalic version. From July 1, 1984 to May 15, 1987, 58 patients who had breech presentations between 37-41 weeks' gestation were considered for external cephalic version. The patients were randomly assigned to one of two groups: tocolytic or no tocolytic. An ultrasound examination, serum alpha-fetoprotein (AFP), Kleihauer-Betke test, and nonstress test (NST) were performed before and after the attempt at version. A version was not attempted if there was evidence of intrauterine growth retardation (IUGR), oligohydramnios, or a nonreactive NST. Patients in the tocolytic group received 200 micrograms/minute of ritodrine hydrochloride for 20 minutes via continuous intravenous infusion before a version was attempted. Twenty of the 30 patients (66.7%) in the tocolytic group and 19 of the 28 patients (67.8%) in the no-tocolytic group had successful versions, a nonsignificant difference. The nine patients with unsuccessful version attempts in the group without a tocolytic then received intravenous ritodrine and underwent a second attempt. Only one of these nine attempts was successful. There were no serious maternal or fetal complications associated with the attempts at version. In our patient population, use of a tocolytic did not significantly increase the probability of a successful version.
Robertson
A W
AW
Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington.
Kopelman
J N
JN
Read
J A
JA
Duff
P
P
Magelssen
D J
DJ
Dashow
E E
EE
D000328:Adult; D001946:Breech Presentation; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D007262:Infusions, Intravenous; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D011897:Random Allocation; D012312:Ritodrine / Q000008:administration & dosage / Q000494:pharmacology*; D014599:Uterus / Q000187:drug effects*; D014710:Version, Fetal / Q000379:methods*
D012312:Ritodrine