Fernandez C O, Bloom S L, Smulian J C, Ananth C V, Wendel G D
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
Obstet Gynecol. 1997 Nov;90(5):775-9. doi: 10.1016/S0029-7844(97)00440-7.
To evaluate the efficacy of subcutaneous terbutaline therapy on the success rate of external cephalic version in term gestation.
Women with singleton noncephalic gestations were assigned randomly to receive either terbutaline (0.25 mg) or placebo. Physicians were blinded to the assignment. Fifteen to 30 minutes after the study drug was administered, external cephalic version was attempted. It was discontinued after three attempts, for patient discomfort, for fetal heart rate decelerations, or when successful. Patients were discharged home after the procedure and allowed to enter spontaneous labor. Primary outcomes evaluated included initial success of version, presentation in labor, and route of delivery.
One hundred three women were enrolled in the study between January 1994 and June 1995, of whom 52 were assigned to terbutaline and 51 to placebo. External cephalic version was successful in 27 of 52 (52%) women receiving terbutaline compared with 14 of 51 (27%) of those receiving placebo (P = .019). This comparison yielded a relative risk (RR) of 1.9 (95% confidence interval [CI] 1.3, 6.5). Four of the 27 (15%) successful versions in the terbutaline group and three of the 14 (21%) successful versions in the placebo group spontaneously reverted to breech presentation. Ultimately, in labor there were 24 (46%) cephalic presentations in the terbutaline group and 13 (25%) in the placebo group (P = .048, RR 1.84, 95% CI 1.1, 5.8). Cesarean delivery rates were 11 of 41 (27%) for women with successful versions and 58 of 62 (94%) among those with failed versions (P < .001).
Terbutaline (0.25 mg) administered subcutaneously before an attempted version in women at term with noncephalic presentations significantly increased the initial success rate of version and the rate of cephalic presentations in labor while decreasing the rate of cesarean delivery.
评估皮下注射特布他林治疗对足月妊娠外倒转术成功率的影响。
将单胎非头位妊娠的女性随机分为两组，分别接受特布他林（0.25毫克）或安慰剂治疗。医生对分组情况不知情。在给予研究药物15至30分钟后，尝试进行外倒转术。若尝试三次后、因患者不适、胎儿心率减速或成功则停止操作。术后患者出院并允许自然分娩。评估的主要结局包括倒转术的初始成功率、分娩时的胎位及分娩方式。
1994年1月至1995年6月期间，103名女性纳入研究，其中52名被分配接受特布他林治疗，51名接受安慰剂治疗。接受特布他林治疗的52名女性中有27名（52%）外倒转术成功，而接受安慰剂治疗的51名女性中有14名（27%）成功（P = 0.019）。该比较得出相对风险（RR）为1.9（95%置信区间[CI] 1.3, 6.5）。特布他林组27例成功倒转术中4例（15%）、安慰剂组14例成功倒转术中3例（21%）胎位自发恢复为臀位。最终，分娩时特布他林组有24例（46%）为头位，安慰剂组有13例（25%）为头位（P = 0.048，RR 1.84，95% CI 1.1, 5.8）。倒转术成功的女性剖宫产率为41例中的11例（27%），倒转术失败的女性剖宫产率为62例中的58例（94%）（P < 0.０01）。
对于足月非头位妊娠女性，在尝试外倒转术前皮下注射特布他林（0.25毫克）可显著提高倒转术的初始成功率和分娩时的头位率，同时降低剖宫产率。
