The optimal anesthesia mothod for external cephalic version (ECV): a randomized controlled trial

Abstract

Background: The aim of the study is to investigate the success rate of ECV and relevant complications with intrathecal analgesia for singleton breech pregnancy.Methods: Sixty pregnant women received obstetrical regular prenatal care were randomly divided into EA group( epidural anesthesia, n = 30), CSEA group( combined spinal-epidural anesthesia, n = 30), control group(no analgesia, n = 30). The primary outcome of our study was the success rate of ECV confirmed by ultrasound. Visual analogue scale,, the rate of cesarean section and relevant side effect were recorded.Results: The success rate of spontaneous inversion to cephalic version was 76.7% in EA group, which was higher than that in CSEA group (53.3%) and control group (46.7%) (p = 0.058 and p = 0.017, respectively). The rate of cesarean section in EA group was 33.3%, which was also lower than that in CSEA group (53.3%) and control group (50.0%), however, the difference was not statistically significant between CSEA group and EA group(p = 0. 19). The VAS scores in the EA group and the spinal group were respectively 1.87 ± 2.94 and 1.73 ± 2.71 ,obviously better than that of the control group (6.84 ± 3.08) (p = 0.001 and p = 0.001).It was no significant difference between EA group and Control group ( p = 0. 118). The incidence of hypotension, nausea and vomiting, and fetal heart rate deceleration in CSEA group was significantly higher than that in control group (p = 0.000, p = 0.161, p = 0.129). The occurrence rate of spontaneous fetal heart rate deceleration in the EA, CSEA and control group were 6.7%, 20% and 6.7%, respectively, the differences were not statistically significant.Conclusions: EA can be more effective to enhance the success rate of spontaneous inversion to cephalic version than CSEA, and CSEA is accompanied with more side effects. Meanwhile, EA or CSEA don’t affect the rate of cesarean section of ECV for breech single pregnancy. (Registration number: ChiCTR1800017124)Trial registration: Name of the registry: Comparison of epidural analgesia with dexmedetomidine or sufentanil combined with ropivacaine: an observational study of multi-center ; Trial registration number: ChiCTR1800017124; Date of registration: 07-13-2018; URL of trial registry record: http://www.chictr.org.cn/edit.aspx?pid=29087&htm=4