ECV with uterine relaxation
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1. Live singleton fetus
2. Breech presentation
3. Gestational age of 32 weeks and onwards
4. Maternal age of 18 years or more
1. Any contra-indication to labour or vaginal birth (eg placenta praevia)
2. Any contra-indication to ECV:
- A scarred uterus other than transverse in the lower segment
- Known uterine anomalies
- Placental abruption in the obstetric history
- Preeclampsia or eclampsia
- Third trimester blood loss (7 days prior to ECV)
- Ruptured membranes
3. Any contra-indication to atosiban or fenoterol:
- Cardiovascular disease
- Elevated liver enzyme or renal dysfunction
- Infection of the amniotic cavity
- Simultaneous use of prostaglandin inhibitors (aspirine, diclofenac, ibuprofen),
beta-blockers (labetalol (trandate), xanthine derivatives (theofylline),
tricyclic antidepressants (amitriptyline, sarotex, tryptizol), calcium, vitamin D.
1. Suspected severe intrauterine growth restriction(<P5 for gestational age assessed by ultrasonography) or severe oligohydramnios (deepest pool <
2. Fetal anomalies or an extended fetal head (very rare)
3. Non reassuring signs of fetal well-being;non-reassuring fetal heart rate monitoring
Main study parameter/endpoint
1. Successful version; number of cephalic presentations half an hour after the procedure
2. Fetal presentation at delivery
1. Mode of delivery; vaginal delivery (spontaneous or instrumental), CS (prelabor or during labor).
2. Complications of ECV; persistent non-reassuring fetal CTG after ECV, occult or overt umbilical cord prolapse, (P)PROM, placental abruption, emergency delivery, fetal death.
3. Adverse events due to atosiban or fenoterol; chest pain, nausea, vomiting, headaches, flushing, dizziness, hypotension (associated with fainting or CTG abnormalities), tachycardia resulting in palpitationsfor more than 5 minutes, local reaction of the skin after injection of the medication, anaphylactic shock, cessation of treatment due to side effects.
Prof.dr. J.A.M. van der Post, gynaecologist, AMC Amsterdam
Prof. dr. B.W. Mol, gynaecologist, AMC Amsterdam