Main Article Content
OBJECTIVE: To find out the role of Terbutaline in external cephalic version (ECV) in terms of successful version to cephalic presentation.
METHODS: This observational study was conducted in Peshawar Health Center (PHC) University Town, Peshawar, Pakistan from 15th August 2015 to 9th November 2016. Patients having uncomplicated breech presentation with 36-42 weeks’ gestation and having no contraindication for ECV were included in the study. All patients were given Injection Terbutaline subcutaneously (s/c) 15 minutes before the procedure. ECV was performed by a single skilled consultant obstetrician. After the procedure the mother and the fetus were observed for any complication. Success was defined in terms of conversion of the fetus from breech to cephalic presentation. All the relevant data including demographic data was entered in a pre-designed proforma and was evaluated using SPSS vs. 17.
RESULTS: A total of 80 patients having uncomplicated breech fetuses at 36-42 weeks were included in the study. Mean age of the patients was 29.37±7.04 years. Twenty-nine were primigravida (36.25%), 38 (47.5%) multigravida and 13 (16.25%) were grand multi gravida. Success rate was 83.7%. There were no serious maternal or fetal complications except 2(2.5%) fetuses having transient bradycardia.
CONCLUSION: Terbutaline is a safe tocolytic drug for ECV in terms of successful version to cephalic presentation.
KEY WORDS: Terbutaline (MeSH), external cephalic version (Non-MeSH), breech presentation (MeSH)
Work published in KMUJ is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
- Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, William AR. Planned cesarean section versus planned vaginal birth for breech presentation at term: A randomized multicenter trial. Lancet 2000;356(9239):1375-83.
- Hutton EK, Hofmery GJ, Dowswell T. External cephalic version for breech presentation before term. Cochrane Database Syst Rev 2015 Jul 29;(7):CD000084. DOI: 10.1002/14651858.CD000084.pub3.
- Su M, Hannah WJ, Willian A, Ross S, Hannah ME; Term Breech Trial Collaborative Group. Planned caesarean section decreases the risk of adverse perinatal outcome due to both labour and delivery complications in the Term Breech Trial. Br J Obstet Gynaecol 2004;111(10):1065-74.
- Royal College of Obstetricians and Gynaecologists. Breech presentation management. Greentop guideline No. 20b, London: RCOG press; 2016:1-13.
- Committee on Obstetric Practice. ACOG committee opinion. Mode of term singleton breech delivery. No.265, December 2001. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2002;77(1):65-6.
- Kok M, Bais JM, van Lith JM, Papastsonis DM, Kleiverda G, Hanny D, et al. Nifedipine as a uterine relaxant for external cephalic version: a randomized controlled trial. Obstet Gynecol 2008;112(2,part1):271-6.
- Choudhary SM, Ayaz A. Effort to reduce cesarean section rate. J Surg Pak March 2003;08(1):25-7.
- Ebner F, Friedl TW, Leinert E, Schramm A,Reister F, Lato K, et al. Predictor for a successful external cephalic version: a single centre experience. Arch Gynecol Obstet 2016 Apr;293(4):749-55.
- Mowat A, Gardener G. Predictor of successful external cephalic version in an Australian maternity hospital. Aust N Z J Obstet Gynaecol 2014 Feb;54(1):59-63. DOI: 10.1111/ajo.12152.
- Cho LY, Lau WL, Lo TK, Tang HH, Leung WC. Predictor of successful outcome after cephalic version in singleton term breech pregnancies: a nine year historical cohort study. Hong Kong Med J 2012;18(1):11-9.
- Zandstra H, Mertens HJ. Improving external cephalic version for foetal breech presentation. Facts Views Vis Obgyn 2013;5(2):85-90.
- Cluver C, Gyte GM, Sinclair M, Dowswell T, Hofmeyr GJ. Intervention for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev 2015 Feb 9;(2): CD000184. DOI:
1002/14651858.CD000184.pub4. Epub 2015 Feb 9.
- Robertson AW, Kopelman JN, Read JA, Duff P, Magelssen DJ, Dashow EE. External cephalic version at term:is a tocolytic necessary? Obstet Gynecol 1987 Dec;70(6):896-9.
- Fernandez CO, Bloom SL, Smulian JC, Ananth CV, Wendel GD. A randomized placebo controlled evaluation of terbutaline for external cephalic version. Obstet Gynecol 1997 Nov;90(5):775-9.
- Hofmeyr G. Interventions to help external cephalic version for breech presentation at term. Cochrane Database Syst Rev 2004;(1):CD000184.
- Tasnim N, Mahmud G, Khurshid M. External cephalic version with salbutamol- success rate and predictors of success. J Coll Physcians Surg Pak 2009 Feb;19(2):91-4. DOI:
- Ismail NAM, Ibrahim M, Naim NM, Mahdy ZA, Jamil MA, Razi ZRM. Nifedipine versus terbutaline for tocolysis in external cephalic version. Int J Gynaecol Obstet 2008 Sep;102(3):263-6. DOI: 10.1016/J.IJGO.2008.04.010
- Collaris R, Tan PC. Oral nifedipine versus subcutaneous terbutaline tocolysis for external cephalic version:a double blind randomised trial. Br J Obstet Gynaecol 2009;116(1):74-80.
- Salim R, Zafran N, Nachum Z, Edelstin S, Shalev E. Employing nifedipine as a tocolytic agent prior to external cephalic version. Acta Obstet Gynaecol Scand 2008;87(4):434-7. DOI: 10.1080/00016340801996598.
- Arif W, Iqbal M, Lodhi SK. Outcome of external cephalic version in terms of success rate and fetomaternal complications. Ann King Edward Med Uni Jan-Mar 2010:16(1):64-8. DOI: 10.21649/akemu.v16i1.142
- Lim PS, Ng BK, Ali A, Shafiee MN, Kampan NC, Ismail NAM, et al. Successful external cephalic version: Factors predicting vaginal birth. Sci World J 2014;2014:860107.
- Kathpalia S, Singh Y, Sharma R. Outcome of external cephalic version in breech presentation. Med J Armed Forces India 2012 Apr;68(2):151-3. DOI: 10.1016/S0377-1237(12)60036-7.
- El-Sayed YY, Pullen K, Riley TE, Lyell D, Druzin ML, Cohen SE, et al. Randomized comparison of intravenous nitroglycerine and subcutaneous terbutaline for external cephalic version under tocolysis. Am J Obstet Gynecol 2004 Dec;191(6):2051-5.
- Wilcox CB, Nassar N, Roberts CL. Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review. Br J Obstet Gynaecol 2011 Mar;118(4):423-8. DOI: 10.1111/j.1471-0528.2010.02824.x