External cephalic version with salbutamol - success rate and predictors of success.

OBJECTIVE: To determine the success rate of External Cephalic Version (ECV) with 0.25 mg Salbutamol in singleton term breech and to identify the predictors of success.

STUDY DESIGN: Quasi experimental study.

PLACE AND DURATION OF STUDY: Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad, from January 2000 to March 2005.

METHODOLOGY: Women, presenting with uncomplicated breech, between 37-40 completed weeks gestation, underwent ECV in day care ward. Fifteen minutes before the procedure, injection salbutamol 0.25 mg was administered subcutaneously. Cases with contraindication to ECV or Salbutamol injection were excluded from the study. The outcome measures included success rate of ECV (in terms of conversion from breech to cephalic presentation at the completion of procedure confirmed through ultrasound), association of maternal and fetal demographic characteristics with successful version and adverse effects related to the procedure in terms of fetal bradycardia, ante-partum still birth, antepartum hemorrhage and preterm labour. Rate of reversion to breech and drug-related side effects were also recorded as secondary outcome measures. Chi-square test was used for categorical variables and independent sample t-test for continuous variables.

RESULTS: Of the 101 ECV procedures, 41 (40.5%) were successful. Success rate was significantly lower in nullipara (p=0.01) and with AFI 7 cm or less (p=0.04). No significant association was found between success rate and gestational age (p=0.35) or fetal birth weight (p=0.57). None of the patient suffered from serious maternal complications. Salbutamol related minor effects (tremors, anxiety and palpitations) were observed in 36 (35.6%) patients. Fetal tachycardia was seen in 17 (16.8%), reversible fetal bradycardia in 3 (2.9%) and intractable fetal bradycardia in one patient.

CONCLUSION: External cephalic version with 0.25 mg Salbutamol was safe and a feasible option in term breech presentation in this series. Administration of tocolytic agent improved the success rate and reduced complication rate of the procedure. Major determinants of success were amniotic fluid index and parity.