A randomized trial of epidural anesthesia to improve external cephalic version success

Anesthetic dose neuraxial blockade increases the success rate of external fetal version: a meta-analysis

“…Meta-Analysis.com) with a random effects model. Heterogeneity was assessed by dividing the studies into subgroups, i.e., those where an anesthetic dose of local anesthetic was used (capable of producing a motor block) [4][5][6] and those with an analgesic dose of local anesthetic A,B,3,7 ( Table 1). The two subgroups were analyzed with the Lan-deMets (O'Brien-Fleming) method for group sequential boundaries calculated at a cumulative a of 0.05 (2-sided symmetric) with the Lan-DeMets Group Sequential Calculations software Version 2 (Department of Biostatistics, University of Wisconsin, Madison, WI, USA).…”

“…A, [3][4][5][6] Fetal bradycardia was reported in four studies; A,3,4,7 the incidence of transient bradycardia was 13 and 22% for the treatment groups and 11 and 15% for the control groups. 3,7 The incidence of persistent bradycardia was 4, 15, and 29% for the treatment groups and 6, 11, and 15% for the control groups.…”

“…4,7 The incidence of placental abruption was mentioned in four studies, with only one occurring in each treatment group (n = 2 total for all studies). B, 3,5,6 The incidence of emergency Cesarean delivery was reported in Epidural: lidocaine 260 mg plus fentanyl 100 lg for sensory level of T 10 Schorr SJ 5 n = 35 n = 34 Appropriate 3…”

External cephalic version in breech presentations at term: comparison of maternal and perinatal outcome with normal pregnancies

“…The success rates by Schorr et al and Carlan et al were 51% and 59% respectively using epidural anaesthesia with 2% lidocaine and terbutaline for tocolysis. 11,12 It is possible that the criteria for selection of patients for version were too stringent thereby limiting the number of patients chosen to only 7.44%. Since ECV is an infrequently performed procedure, the limited experience of the obstetricians may also be a reason for the low success rate of ECV.…”

Anesthesia-facilitated external cephalic version: pennywise or pound-foolish?

“…To date, the effectiveness of neuraxial anesthesia for ECV has been evaluated in 1,112 patients in 14 studies: 572 patients received a neuraxial technique and 540 received either intravenous analgesia or no analgesia (Table). [11][12][13][14][15][16][17][18][19][20][21][22][23][24] For major complications, including emergency Cesarean delivery, persistent bradycardia, and placental abruption, there appears to be no difference in the incidence of 11,15,20 (two NA vs two NNA), and 14 cases of persistent bradycardia 12,18,19 (eight NA vs six NNA). It is important to recognize that some of these studies, particularly the non-randomized ones, failed to report specifically on the incidence of complications, making this information more difficult to interpret.…”