External cephalic version with tocolysis. Observations and continuing experience at the Los Angeles County/University of Southern California Medical Center.

Abstract

We considered 113 consecutive patients for attempted external cephalic version with tocolysis (ECV-T) after 37 weeks' gestation. We randomized the first patients to the control group (no ECV-T attempted, 23 patients) or the study group (ECV-T attempted, 25 patients). Nine patients were excluded, and ECV-T was then considered for 88 patients, with a success rate of 77% for the 104 total attempts. Six patients were lost to follow-up. In the successful ECV-T group, 71 of 75 patients (95%) presented the vertex in labor, while 4 patients (5%) reverted to breech. Uterine exploration at delivery revealed uterine anomalies in three of the patients who reverted. The cesarean rate was 25% in the successful-ECV-T group and 87% in the failed-ECV-T group. In the initial group, four patients (18%) spontaneously converted to cephalic presentations after 37 weeks. None of the failed-ECV-T patients spontaneously converted to cephalic presentations. The cesarean rate for the control and failed-ECV-T patients presenting the breech intrapartum was 88%. Complications included transient fetal bradycardia in 37 patients (36%), evidence of fetomaternal bleeding (positive Kleihauer-Betke test) in 2 patients (2%) and one fetal demise three weeks following successful ECV-T and diagnosed at the onset of labor. We lowered the cesarean section rate for breech presentation in labor with the selective application of ECV-T late in gestation. We consider this technique to be a powerful addition to our armamentarium for managing the term breech presentation.