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Terbutaline Versus Nitroglycerin for External Cephalic Version
Abstract Number: F3B-3
Abstract Type: Original Research
Objective: Compare the success rate of external cephalic version (ECV) in parturients between IV Nitroglycerin (IV NTGL) versus Terbutaline (TERB)
Methods: This is a retrospective study of ECV cases from 2007-2017. The rate of successful ECV, vaginal delivery, and cesarean section were collected. Data were also collected for subjects’ height, weight, gravidity, parity, weeks of gestation, fetal positions, placental positions, type of breech, composition and amount of spinal medications, and amniotic fluid index (AFI). The data for 153 subjects who received either IV NTGL (92 subjects, 60.1% of total), TERB (61 subjects, 39.9% of total) were compared.
Results: Variables such as height, weight, gravidity, parity, weeks of gestation weren’t statistically different between groups. There were no statistically significant differences between fetal positions, placental positions, type of breech, and intrathecal medications. The median AFI was 12 (IQR [10-14]) in the IV NTGL group and 11 (IQR [10-13.5]) in the TERB group. The differences between groups were tested via the Man Whitney U for continuous non-normal variables and chi square tests for categorical variables. The ECV success rate was 40/62 or 65% for the TERB group and 38/92 or 41% for the IV NTGL group p=0.003 (Chi-Square Test). The vaginal delivery success rate was 36/61 or 59% in the TERB group and 35/92 38% in the IV NTGL group p=0.011 (Chi Square Test).
Conclusion: ECV reduces the frequency of breech delivery at term and lessens the risks with breech delivery and those of cesarean section (1–4). Tocolytocs, administered immediately prior to the ECV, have been shown to improve the success rate of ECV(1–4). Several agents are known to cause tocolysis including beta-mimetics and NTGL (1,2,4). Our study demonstrates that in patients presenting for ECV, terbutaline is associated with a higher success rate. This has been shown in another work(4), however, our study includes a much larger cohort. A limitation of our study is that its retrospective design does not allow for comparing the difference between the dose and timing of nitroglycerin, which is important for the drug’s short duration of action(3). A prospective study is needed to further evaluate the effectiveness of IV Nitroglycerin versus terbutaline.
1. Bujold E et al J Obstet Gynaecol Can. 2003
2. Bujold E et al. American Journal of Obstetrics and Gynecology. 2003
3. Hilton J et al. Obstet Gynecol. 2009
4. El-Sayed YY et al. Am J Obstet Gynecol. 2004