Effectiveness of epidural anesthesia for external cephalic version (ECV)

Abstract

Objective: The Cochrane review conducted in 2001 re-established the usefulness of external cephalic version (ECV). The success rate for ECV using epidural anesthesia or spinal anesthesia is reported to be 35 to 86%. In this study, we examined the effectiveness of epidural anesthesia for ECV.Study Design: A retrospective cohort study was conducted of pregnant women who were at 35 to 36 weeks of gestation between 2001 and June 2009, with a single fetus, non-cephalic presentation and without nonreassuring fetal status. The subjects were ultrasonographically examined for placental location, presence/absence of nuchal cord and amniotic fluid volume. Those with placenta previa, early rupture of membranes, uterine anomaly or severe fetal anomaly and those in whom delivery was initiated were excluded from the study. The study protocol was approved by the institutional ethics committee, and written informed consent was obtained for all procedures described in the protocol. The success rate for ECV was compared between the anesthesia and non-anesthesia groups. Analysis was also performed to identify factors contributing to successful ECV.Result: There were 86 women with non-cephalic presentation who underwent ECV during the study period. The non-anesthesia group consisted of 34 women in whom ritodrine hydrochloride, a tocolytic agent, was administered alone, and 52 women in whom a tocolytic agent and epidural anesthesia were used constituted the anesthesia group. There were no significant differences between the two groups in terms of age, parity, body mass index and placental location. The success rate for ECV was 55.9% (19/34 patients) in the non-anesthesia group and 78.8% (41/52 patients) in the anesthesia group, showing a significant difference between the two groups (odds ratio 1.75, 95% confidence interval 1.26 to 2.44). Analysis was also performed to identify factors determining successful ECV other than epidural anesthesia from among age, parity, body mass index, placental location, presence/absence of uterine myoma, nuchal code and previous cesarean delivery; however, none of the factors identified was found to be a significant determinant factor. Conclusion:The use of epidural anesthesia significantly increases the success rate for ECV for breech presentation.

Neuraxial blockade for external cephalic version: a systematic review

“…Three were retrospective analyses (Yoshida, 36 Carlan 63 and Cherayil 64 ) and three were prospective non-randomized studies (Birnbach, 65 Rozenberg 66 and Neiger 67 ). Two studies performed prospective trials on patients undergoing repeat ECV.…”

“…30,32 Due to limited data and heterogeneity among the studies, there was insufficient evidence to recommend routine use of neuraxial blockade for ECV. More recent studies have examined the role of neuraxial blockade for ECV, [33][34][35][36] and provide further evidence to support the use of neuraxial blockade to improve the success rate of ECV.…”

Predictors of success of external cephalic version and cephalic presentation at birth among 1253 women with non‐cephalic presentation using logistic regression and classification tree analyses

“…These observations can be explained in part by uncertainty around the likelihood of success associated with ECV , as the reported rates of success are relatively low . Previous studies have attempted to elucidate factors that may be useful in predicting the probability of ECV success , but none have considered outcomes for clinically relevant groupings of women using classification and regression tree (CART) analyses.…”

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.…”