Cochrane: Babies born in the breech position (bottom first) are at increased risk
of complications at birth because of a delay in birth of the head.
Turning a breech baby to head first in late pregnancy may reduce these
complications.
A procedure called 'external cephalic version (ECV)' describes when practitioners use their hands on the woman's abdomen to gently try to turn the baby from the breech position to head first. A number of treatments may help the success of ECV. These include using tocolytic drugs (drugs like beta stimulants and calcium channel blockers that relax the womb), stimulating the baby with sound through the mother’s abdomen (acoustic stimulation), increasing the fluid surrounding the baby (transabdominal amnioinfusion), injecting pain-relieving drugs into the mother’s lower back to produce regional analgesia (epidural or spinal analgesia), giving the mother opioid drugs to help her relax, using hypnosis and applying gel or talcum powder to the mother's abdomen.
This review of trials found 28 randomised controlled studies involving 2786 women. Most studies looked at the effects of tocolytic beta stimulant drugs. Results showed that babies are more likely to turn head first during ECV and to remain head first for the start of labour, if women receive beta stimulants. These drugs also reduced the number of caesarean sections, but insufficient data on possible adverse effects were collected. Little information on other types of tocolytic drugs was available, although nitric oxide donors were associated with an increase in headaches. In addition, too little evidence was available to show whether the other ways of trying to help ECV are effective. Further research is needed if we are to increase the success of ECV.
A procedure called 'external cephalic version (ECV)' describes when practitioners use their hands on the woman's abdomen to gently try to turn the baby from the breech position to head first. A number of treatments may help the success of ECV. These include using tocolytic drugs (drugs like beta stimulants and calcium channel blockers that relax the womb), stimulating the baby with sound through the mother’s abdomen (acoustic stimulation), increasing the fluid surrounding the baby (transabdominal amnioinfusion), injecting pain-relieving drugs into the mother’s lower back to produce regional analgesia (epidural or spinal analgesia), giving the mother opioid drugs to help her relax, using hypnosis and applying gel or talcum powder to the mother's abdomen.
This review of trials found 28 randomised controlled studies involving 2786 women. Most studies looked at the effects of tocolytic beta stimulant drugs. Results showed that babies are more likely to turn head first during ECV and to remain head first for the start of labour, if women receive beta stimulants. These drugs also reduced the number of caesarean sections, but insufficient data on possible adverse effects were collected. Little information on other types of tocolytic drugs was available, although nitric oxide donors were associated with an increase in headaches. In addition, too little evidence was available to show whether the other ways of trying to help ECV are effective. Further research is needed if we are to increase the success of ECV.
Authors' conclusions:
Parenteral beta stimulants
were effective in facilitating successful ECV, increasing cephalic
presentation in labour and reducing the caesarean section rate, but data on adverse effects were insufficient. Data on calcium channel blockers and nitric acid donors were insufficient to provide good evidence.
The scope for further research is clear. Possible benefits of tocolysis in reducing the force required for successful version and possible risks of side effects need to be addressed further. Further trials are needed to compare the effectiveness of routine versus selective use of tocolysis and the role of regional analgesia, fetal acoustic stimulation, amnioinfusion and abdominal lubricants, and the effects of hypnosis, in facilitating ECV. Although randomised trials of nitric oxide donors are small, the results are sufficiently negative to discourage further trials. Intervention fidelity for ECV can be enhanced by standardisation of the techniques and processes used for clinical manipulation of the fetus in the abdominal cavity and ought to be the subject of further research.
The scope for further research is clear. Possible benefits of tocolysis in reducing the force required for successful version and possible risks of side effects need to be addressed further. Further trials are needed to compare the effectiveness of routine versus selective use of tocolysis and the role of regional analgesia, fetal acoustic stimulation, amnioinfusion and abdominal lubricants, and the effects of hypnosis, in facilitating ECV. Although randomised trials of nitric oxide donors are small, the results are sufficiently negative to discourage further trials. Intervention fidelity for ECV can be enhanced by standardisation of the techniques and processes used for clinical manipulation of the fetus in the abdominal cavity and ought to be the subject of further research.