**11. Making the ECV easier**

The procedures that have proved their usefulness in randomized studies are only the tocolytics aiming at relaxing the uterus at the version.

In a 2005 *Cochrane*'s review, tocolytics were related to a reduction of the failure risk in external cephalic version both with nulliparous and multiparous women, as well as to a reduction in the caesarean rate. In the "tocolytic groups" the achievement of the external cephalic version in a minute and the fetal bradycardia was less common. These results are valid for tocolytics such as ritodrine, salbutamol and terbutaline (both by an intravenous or subcutaneous injection). However, no evidence has been proved in order to use other tocolytics suggested in other projects (such as the intravenous nitroglycerin, sublingual glyceryl trinitrate or nifidipine). Thus, pregnant women should be warned about the tocolytics adverse effects (evidence level Ia and recommendation level A).

In the same revision it was concluded that despite the fact that many multiple studies have been carried out, there is not enough scientific evidence proving the use of epidural analgesia, vibroacoustic stimulation or amnioinfusion in order to facilitate the version.

A small prospective study published in 2010 concluded that the factors increasing the probability of success and reducing the rate of adverse effects in ECV are a single attempt at the maneuver, total duration of the maneuver of less than 5minutes, and use of salbutamol as a uterine relaxant (Delgado et al, 2010). use a

There were contradictory results regarding the outcomes using the epidural or spinal analgesia to facilitate the version maneuvers. Therefore, the use of regional analgesia in order to facilitate the external cephalic version cannot be recommended.

In the case of the acoustic stimulation of the fetus, there is a small project which proved a significant reduction in the external cephalic version failure rate in midline fetal spine positions. Nevertheless, as this project is small, the confirmation of the results by other projects is necessary before including this procedure into the clinical practice.

No randomized clinical studies on the amnioinfusion practices as a method to facilitate the external version were found.
