External cephalic version facilitation for breech presentation at term.

Abstract

BACKGROUND: Successful external cephalic version at a late stage of pregnancy was considered to be possible only with the use of tocolytic drugs to relax the uterus. Other methods are also used in an attempt to facilitate external cephalic version at term. OBJECTIVES: The objective of this review was to assess the effects of routine tocolysis, fetal acoustic stimulation, epidural anaesthesia and transabdominal amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: February 1999. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing routine versus selective tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural analgesia versus no epidural analgesia; or transabdominal amnioinfusion versus no amnioinfusion for external cephalic version at term. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by the reviewer. MAIN RESULTS: Six trials were included. Routine tocolysis was associated with fewer failures of external cephalic version (relative risk 0.77, 95% confidence interval 0.64 to 0.92). There were no significant differences between non-cephalic presentations and caesarean sections. 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). No randomised trials of epidural analgesia or transabdominal amnioinfusion for external cephalic version at term were located. REVIEWER'S 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. There is not enough evidence to evaluate the use of epidural analgesia or transabdominal amnioinfusion for external cephalic version at term.