External cephalic version facilitation for breech presentation at term.
BACKGROUND
Tocolytic drugs to relax the uterus as well as other methods have been also used in an attempt to facilitate external cephalic version at term.


OBJECTIVE
The objective of this review is to assess the effects of routine tocolysis, fetal acoustic stimulation, epidural or spinal analgesia and transabdominal amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome.


METHODS
The Cochrane Pregnancy and Childbirth Group Trials Register and the Cochrane Controlled Trials Register were searched. Date of last search: April 2001.


METHODS
Randomised and quasi-randomised trials comparing routine versus selective tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural or spinal analgesia versus no regional analgesia; or transabdominal amnioinfusion versus no amnioinfusion for external cephalic version at term.


METHODS
Eligibility and trial quality were assessed by the reviewer.


RESULTS
In seven trials, routine tocolysis was associated with fewer failures of external cephalic version (relative risk 0.74, 95% confidence interval 0.64 to 0.87). There were no significant differences between non-cephalic presentations at birth. Caesarean sections were reduced (relative risk 0.85, confidence interval 0.72-0.99). Fetal acoustic stimulation in midline fetal spine positions was associated with fewer failures of external cephalic version at term (relative risk 0.17, 95% confidence interval 0.05 to 0.60). With epidural or spinal analgesia, external cephalic version failure, non-cephalic births and caesarean sections were reduced in one trial but not the other. The overall differences were not statistically significant. No randomised trials of transabdominal amnioinfusion for external cephalic version at term were located.


CONCLUSIONS
Routine tocolysis appears to reduce the failure rate of external cephalic version at term. Although promising, there is not enough evidence to evaluate the use of fetal acoustic stimulation in midline fetal spine positions, nor of epidural or spinal analgesia. Large volume intravenous preloading may have contributed to the effectiveness demonstrated in one of the latter trials. No randomised trials of transabdominal amnioinfusion for external cephalic version at term were found.
Hofmeyr
G J
GJ
(Director, Effective Care Research Unit, University of the Witwatersrand), Frere/Cecilia Makiwane Hospitals, Private Bag 9047, East London 5200, Eastern Cape, South Africa. gjh@global.co.za
D001946:Breech Presentation; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D011247:Pregnancy; D015145:Tocolysis; D014710:Version, Fetal / Q000379:methods