Tasnim Nasira, Mahmud Ghazala, Khurshid Mona
Department of Obstetrics and Gynaecology, Pakistan Institute of Medical Sciences, Islamabad.
J Coll Physicians Surg Pak. 2009 Feb;19(2):91-4.
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.
Quasi experimental study.
Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad, from January 2000 to March 2005.
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.
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.
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.
确定使用0.25毫克沙丁胺醇进行外倒转术（ECV）在单胎足月臀位中的成功率，并确定成功的预测因素。
准实验研究。
2000年1月至2005年3月，位于伊斯兰堡的巴基斯坦医学科学研究所母婴健康中心。
妊娠37 - 40足周、单纯臀位的孕妇在日间病房接受外倒转术。手术前15分钟，皮下注射0.25毫克沙丁胺醇。有外倒转术或沙丁胺醇注射禁忌症的病例被排除在研究之外。观察指标包括外倒转术的成功率（通过超声确认手术结束时从臀位转为头位的情况）、孕产妇和胎儿人口统计学特征与成功倒转的关联以及与手术相关的不良影响，如胎儿心动过缓、产前死产、产前出血和早产。转为臀位的发生率和药物相关副作用也作为次要观察指标记录。分类变量采用卡方检验，连续变量采用独立样本t检验。
在101例外倒转术操作中，41例（40.5%）成功。初产妇的成功率显著较低（p = 0.01），羊水指数为7厘米或更低时成功率也显著较低（p = 0.04）。未发现成功率与孕周（p = 0.35）或胎儿出生体重（p = 0.57）之间存在显著关联。没有患者出现严重的孕产妇并发症。36例（35.6%）患者观察到与沙丁胺醇相关的轻微影响（震颤、焦虑和心悸）。17例（16.8%）出现胎儿心动过速，3例（2.9%）出现可逆性胎儿心动过缓，1例出现顽固性胎儿心动过缓。
在本系列研究中，使用0.25毫克沙丁胺醇进行外倒转术在足月臀位中是安全且可行的选择。使用宫缩抑制剂提高了手术成功率并降低了并发症发生率。成功的主要决定因素是羊水指数和产次。
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