Transfusion and bleeding risk associated with terbutaline administration for external cephalic version among patients delivering the same day: a retrospective cohort study using the Premier Healthcare Database (2016-2020)

Int J Obstet Anesth. 2026 Jun 6;67:105215. doi: 10.1016/j.ijoa.2026.105215. Online ahead of print.

ABSTRACT

INTRODUCTION: The administration of pre-procedural terbutaline is associated with increased success for external cephalic version, and its use for this purpose is supported by the American College of Obstetricians and Gynecologists. However, terbutaline's uterine relaxant effect may potentially increase the risk of bleeding in the postpartum period, though this association has not been studied.

METHODS: Using the Premier Healthcare Database, need for blood transfusion and postpartum hemorrhage incidence were examined in singleton pregnancies with an external cephalic version on the date of delivery between 2016 and 2020. Blood transfusion was identified using charge codes on the Premier dataset and International Classification of Disease, 10th revision procedure codes on delivery hospitalization records. Postpartum hemorrhage was identified using International Classification of Disease, 10th revision diagnosis codes on delivery hospitalization records. Incidence of blood transfusion and postpartum hemorrhage were compared among pregnancies meeting inclusion criteria who did and did not receive terbutaline.

RESULTS: Among the 9,030 cases with external cephalic during the study period, patients who received terbutaline for external cephalic version (26.3%) had lower overall incidence of postpartum hemorrhage compared to patients who did not receive terbutaline. When stratified by route of delivery, postpartum hemorrhage incidence remained lower for patients receiving terbutaline who delivered via spontaneous vaginal delivery, with no other statistically significant differences in blood transfusion or postpartum hemorrhage incidence.

CONCLUSION: Terbutaline for tocolysis in the context of external cephalic version was not associated with increased incidence of blood transfusion or postpartum hemorrhage, irrespective of delivery mode. These findings should be interpreted with caution, given an inability to adjust for confounding factors.

PMID:42349310 | PMC:PMC13305204 | DOI:10.1016/j.ijoa.2026.105215