Atosiban versus fenoterol as a uterine relaxant for external cephalic version
Autor: | Ben W.J. Mol, Corine J.M. Verhoeven, Joost Velzel, Marjolein Kok, Mariëlle G. van Pampus, Joris A. M. van der Post, Dimitri N.M. Papatsonis, Joke M.J. Bais, Brent C. Opmeer, Liesbeth van der Esch, Floortje Vlemmix, Jan Molkenboer, Karlijn C. Vollebregt |
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Přispěvatelé: | Other departments, APH - Methodology, Clinical Research Unit, Obstetrics and Gynaecology, APH - Quality of Care, ARD - Amsterdam Reproduction and Development, Midwifery Science |
Jazyk: | angličtina |
Rok vydání: | 2017 |
Předmět: |
Adult
medicine.medical_treatment law.invention 03 medical and health sciences 0302 clinical medicine Vasotocin Randomized controlled trial Breech presentation law Pregnancy medicine Humans 030212 general & internal medicine Breech Presentation Version Fetal Fenoterol Netherlands 030219 obstetrics & reproductive medicine business.industry Cesarean Section Cephalic presentation Research Pregnancy Outcome Gestational age Atosiban General Medicine Tocolytic Agents External cephalic version Anesthesia Female Presentation (obstetrics) business medicine.drug |
Zdroj: | The BMJ BMJ (Clinical research ed.), 356. British Medical Association BMJ (Online), 356:i6773. BMJ Publishing Group Velzel, J, Vlemmix, F, Opmeer, B C, Molkenboer, J F M, Verhoeven, C J, Van Pampus, M G, Papatsonis, D N M, Bais, J M J, Vollebregt, K C, Van Der Esch, L, Van Der Post, J A M, Mol, B W & Kok, M 2017, ' Atosiban versus fenoterol as a uterine relaxant for external cephalic version : Randomised controlled trial ', BMJ (Online), vol. 356, i6773 . https://doi.org/10.1136/bmj.i6773 |
ISSN: | 0959-8146 0959-8138 |
Popis: | Objective To compare the effectiveness of the oxytocin receptor antagonist atosiban with the beta mimetic fenoterol as uterine relaxants in women undergoing external cephalic version (ECV) for breech presentation. Design Multicentre, open label, randomised controlled trial. Setting Eight hospitals in the Netherlands, August 2009 to May 2014. Participants 830 women with a singleton fetus in breech presentation and a gestational age of more than 34 weeks were randomly allocated in a 1:1 ratio to either 6.75 mg atosiban (n=416) or 40 μg fenoterol (n=414) intravenously for uterine relaxation before ECV. Main outcome measures The primary outcome measures were a fetus in cephalic position 30 minutes after the procedure and cephalic presentation at delivery. Secondary outcome measures were mode of delivery, incidence of fetal and maternal complications, and drug related adverse events. All analyses were done on an intention-to-treat basis. Results Cephalic position 30 minutes after ECV occurred significantly less in the atosiban group than in the fenoterol group (34% v 40%, relative risk 0.73, 95% confidence interval 0.55 to 0.93). Presentation at birth was cephalic in 35% (n=139) of the atosiban group and 40% (n=166) of the fenoterol group (0.86, 0.72 to 1.03), and caesarean delivery was performed in 60% (n=240) of women in the atosiban group and 55% (n=218) in the fenoterol group (1.09, 0.96 to 1.20). No significant differences were found in neonatal outcomes or drug related adverse events. Conclusions In women undergoing ECV for breech presentation, uterine relaxation with fenoterol increases the rate of cephalic presentation 30 minutes after the procedure. No statistically significant difference was found for cephalic presentation at delivery. Trial registration Dutch Trial Register, NTR 1877. |
Databáze: | OpenAIRE |
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