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Lomas S, Minton Z, Daniels J. Systematic review of the effectiveness of remifentanil in term breech pregnancies undergoing external cephalic version. Int J Obstet Anesth 2023; 54:103649. [PMID: 36989876 DOI: 10.1016/j.ijoa.2023.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND External cephalic version (ECV) is a moderately painful procedure used to turn a fetus from a non-vertex to cephalic position. This systematic review and meta-analysis compared intravenous remifentanil with other analgesia or no analgesia or placebo on the success rate and associated pain of ECV. METHODS Systematic searches for randomised controlled trials using remifentanil during ECV for non-cephalic term singleton pregnancies were conducted in EMBASE, MEDLINE and Cochrane Library to October 2021. The primary outcomes were successful ECV and maternal pain; secondary outcomes included mode of delivery and adverse effects. The Cochrane Risk of Bias tool was used and meta-analysis undertaken if there were ≥2 comparable studies. RESULTS Four trials were identified, three placebo-controlled and one vs no analgesia, totalling 482 participants. Comparisons against nitrous oxide or neuraxial anaesthesia were not analysed. Two studies had a low overall risk of bias, and two had some concern for bias. Remifentanil compared with placebo increased the success of ECV by 43% (risk ratio [RR] 1.43; 95% confidence interval [CI] 1.14 to 1.78). Pain scores (0-10) were lower (mean difference -1.97; 95% CI -2.49 to -1.46) whilst there was no impact on caesarean delivery rate (RR 0.97; 95% CI 0.81 to 1.17). Adverse events were rare, with fetal bradycardia observed less often with remifentanil than placebo. CONCLUSIONS Remifentanil increases the procedural success of ECV and reduces pain compared with placebo. Trials were at low risk of bias and contained a sufficient number of participants to have reasonable confidence in this finding.
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Sedation with Propofol plus Paracetamol in External Cephalic Version: An Observational Study. J Clin Med 2022; 11:jcm11030489. [PMID: 35159941 PMCID: PMC8836497 DOI: 10.3390/jcm11030489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
Although the influence of neuraxial anesthesia or sedation with remifentanil in external cephalic version (ECV) is widely known, ECV results using propofol have not been previously analyzed. This study aimed to evaluate ECV outcomes when propofol was used. An observational analysis of ECV was performed between 1 January 2018 and 31 December 2020. ECV was accomplished with tocolysis and propofol. One hundred and thirty-one pregnant women were recruited. The propofol mean dose was 156.1 mg (SD 6.1). A cephalic presentation was achieved in 61.1% (80/131) of the pregnant women. In total, 56.7% (38/67) of pregnant women with cephalic presentation at labor had a spontaneous delivery, 26.9% (18/67) had an operative delivery, and an intrapartum urgent cesarean section was performed in 16.4% (11/67). In total, 46 pregnant women (35.9%) were scheduled for an elective cesarean section due to non-cephalic presentation. The emergency cesarean section rate during the following 24 h was 10.7% (14/131). A major ECV complication arose in 15 cases (11.5%). ECV outcomes when propofol was used seems to be similar to those with other anesthetic adjunct, so sedation with propofol could be an adequate option for ECV. More studies are needed to compare its effectiveness with neuraxial techniques.
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Weiniger CF, Rabkin V. Neuraxial block and success of external cephalic version. BJA Educ 2021; 20:296-297. [PMID: 33456963 DOI: 10.1016/j.bjae.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- C F Weiniger
- Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - V Rabkin
- Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel
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Hao Q, Hu Y, Zhang L, Ross J, Robishaw S, Noble C, Wu X, Zhang X. A Systematic Review and Meta-analysis of Clinical Trials of Neuraxial, Intravenous, and Inhalational Anesthesia for External Cephalic Version. Anesth Analg 2020; 131:1800-1811. [PMID: 32282385 PMCID: PMC7643798 DOI: 10.1213/ane.0000000000004795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND External cephalic version (ECV) is a frequently performed obstetric procedure for fetal breech presentation to avoid cesarean delivery. Neuraxial, intravenous, and inhalational anesthetic techniques have been studied to reduce maternal discomfort caused by the forceful manipulation. This study compares the effects of these anesthetic techniques on ECV and incidence of cesarean delivery. METHODS We conducted a comprehensive literature search for published randomized controlled trials (RCTs) or well-conducted quasi-randomized trials of ECV performed either without anesthesia or under neuraxial, intravenous, or inhalational anesthesia. Pairwise random-effects meta-analyses and network meta-analyses were performed to compare and rank the perinatal outcomes of the 3 anesthetic interventions and no anesthesia control, including the rate of successful version, cesarean delivery, maternal hypotension, nonreassuring fetal response, and adequacy of maternal pain control/satisfaction. RESULTS Eighteen RCTs and 1 quasi-randomized trial involving a total of 2296 term parturients with a noncephalic presenting singleton fetus were included. ECV under neuraxial anesthesia had significantly higher odds of successful fetal version compared to control (odds ratio [OR] = 2.59; 95% confidence interval [CI], 1.88-3.57), compared to intravenous anesthesia (OR = 2.08; 95% CI, 1.36-3.16), and compared to inhalational anesthesia (OR = 2.30; 95% CI, 1.33-4.00). No association was found between anesthesia interventions and rate of cesarean delivery. Neuraxial anesthesia was associated with higher odds of maternal hypotension (OR = 9.33; 95% CI, 3.14-27.68). Intravenous anesthesia was associated with significantly lower odds of nonreassuring fetal response compared to control (OR = 0.36; 95% CI, 0.16-0.82). Patients received neuraxial anesthesia reported significantly lower visual analog scale (VAS) of procedure-related pain (standardized mean difference [SMD] = -1.61; 95% CI, -1.92 to -1.31). The VAS scores of pain were also significantly lower with intravenous (SMD = -1.61; 95% CI, -1.92 to -1.31) and inhalational (SMD = -1.19; 95% CI, -1.58 to -0.8) anesthesia. The VAS of patient satisfaction was significantly higher with intravenous anesthesia (SMD = 1.53; 95% CI, 0.64-2.43). CONCLUSIONS Compared to control, ECV with neuraxial anesthesia had a significantly higher successful rate; however, the odds of maternal hypotension increased significantly. All anesthesia interventions provided significant reduction of procedure-related pain. Intravenous anesthesia had significantly higher score in patient satisfaction and lower odds of nonreassuring fetal response. No evidence indicated that anesthesia interventions were associated with significant decrease in the incidence of cesarean delivery compared to control.
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Affiliation(s)
- Qingzhong Hao
- From the Division of Anesthesiology, Geisinger Medical Center, Danville, Pennsylvania
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger Medical Center, Danville, Pennsylvania
| | - Li Zhang
- From the Division of Anesthesiology, Geisinger Medical Center, Danville, Pennsylvania
| | - John Ross
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania
| | - Sarah Robishaw
- From the Division of Anesthesiology, Geisinger Medical Center, Danville, Pennsylvania
| | - Christine Noble
- From the Division of Anesthesiology, Geisinger Medical Center, Danville, Pennsylvania
| | - Xianren Wu
- From the Division of Anesthesiology, Geisinger Medical Center, Danville, Pennsylvania
| | - Xiaopeng Zhang
- From the Division of Anesthesiology, Geisinger Medical Center, Danville, Pennsylvania
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Katz D, Riley K, Kim E, Beilin Y. Comparison of Nitroglycerin and Terbutaline for External Cephalic Version in Women Who Received Neuraxial Anesthesia: A Retrospective Analysis. Anesth Analg 2020; 130:e58-e62. [PMID: 30985380 DOI: 10.1213/ane.0000000000004155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
External cephalic version is a technique that decreases the need for cesarean delivery in patients with breech presentation. Several techniques exist to increase the success of external cephalic version; however, there are no studies comparing different tocolytics in patients who also received neuraxial anesthesia. We, therefore, performed a review of 198 patients who presented for external cephalic version and compared their success rates based on the tocolytic medication utilized. The external cephalic version success rate for patients who received terbutaline was significantly higher than for those who received nitroglycerin (N [%]: 57 [65.6] terbutaline group versus 40 [36.0] nitroglycerin group; P < .001).
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Affiliation(s)
- Daniel Katz
- From the *Department of Anesthesiology, Pain, and Perioperative Medicine, Icahn School of Medicine, New York, New York †Department of Internal Medicine, Northwell Health John T. Mather Memorial Hospital, Port Jefferson, New York ‡City University of New York School of Medicine, New York, New York §Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine, New York, New York
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Mu XH, Shi HX, An R. Anesthesia efficacy of bupivacaine in pregnant participants with breech presentation receiving external cephalic version: A protocol of systematic review of randomized controlled trials. Medicine (Baltimore) 2020; 99:e20786. [PMID: 32569223 PMCID: PMC7310873 DOI: 10.1097/md.0000000000020786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of this study is to appraise the efficacy and safety of bupivacaine in pregnant participants with breech presentation (BP) receiving external cephalic version (ECV). METHODS The following electronic databases will be searched from the origin to the January 31, 2020: PUBMED, EMBASE, Cochrane Library, CINAHL, ACMD, PsycINFO, Scopus, OpenGrey, and China National Knowledge Infrastructure. No language and publication time limitations will be applied to all of them. Randomized controlled trials comparing bupivacaine to other interventions for pain relief in pregnant participants with BP undergoing ECV will be included in this study. Two authors will employ the selection of searched records, extraction of essential data from included RCTs, and risk of bias assessment for each eligible trail independently and respectively. Any doubts between 2 authors will be figured out by a third author through discussion. The risk of bias assessment will be judged using Cochrane risk of bias tool. The data pooling and analysis will be performed using RevMan 5.3 software. RESULTS This study will summarize the up-to-date high-quality evidence and will synthesis the outcome data from that evidence to explore the efficacy and safety of bupivacaine for pain relief in pregnant participants with BP undergoing ECV. CONCLUSION The findings of this study may present important guidance for patients, clinical practice, as well as health-policy makers regarding the utilization of bupivacaine for pain relief in pregnant participants with BP receiving ECV. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020164409.
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Affiliation(s)
- Xin-hua Mu
- Department of Anaesthesiology, The Affiliated Hospital of Inner Mongolia Medical University
| | - Hai-Xia Shi
- Department of Anaesthesiology, The Affiliated Hospital of Inner Mongolia Medical University
| | - Ran An
- Department of Emergency, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Ducarme G. [Breech Presentation: CNGOF Guidelines for Clinical Practice - External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation]. ACTA ACUST UNITED AC 2019; 48:81-94. [PMID: 31678503 DOI: 10.1016/j.gofs.2019.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide guidelines regarding efficiency and safety of external cephalic version (ECV) attempt and alternatives methods to turn breech babies to cephalic presentation. METHODS MedLine and Cochrane Library databases search in French and English and review of the main foreign guidelines between 1980 and 2019. RESULTS ECV is associated with a decreasing rate of breech presentation at birth (LE2), and potentially with a lower rate of cesarean section (LE3) without an increase of severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV should be attempt (Professional consensus). ECV attempt should be performed with immediate access to an operating room for emergency cesarean (Professional consensus). The ECV attempt before 37 weeks, compared to ECV attempt after 37 weeks, increases the rate of cephalic presentation at birth (LE2) but with a small increase risk of moderate prematurity (LE2). ECV attempt should be performed from 36SA (Professional consensus). The main factors associated with successful ECV attempt are multiparity (LE3) and no maternal obesity (LE3). Parenteral tocolysis (β mimetic or atosiban), for ECV attempt at term is associated with a higher success rate (LE2), higher rate of achieved cephalic presentation in labor (LE2) and a lower cesarean section rate (LE2). It is recommended to use parenteral tocolysis for ECV attempt at term in order to increase its success rate (grade B). The ECV attempt is associated with an increase in transient FHR abnormalities (LE3), it is therefore recommended that cardiotocography should be performed prior and during 30minutes after the procedure (Professional consensus). There is no argument for recommending the practice of delayed cardiotocography after ECV attempt (Professional consensus). The risk of significant positivity (>30mL) of the Kleihauer test after ECV attempt is low (<0.1%) (LE3), it is not recommended to systematically perform a Kleihauer test after ECV attempt (professional consensus). In case of RH-1 negative women, it is recommended to ensure systematic RH-1 prophylaxis (Professional consensus). In case of breech presentation at term, acupuncture, moxibustion and postural methods are not effective in reducing breech presentation at birth (LE2), and are therefore not recommended (Grade B). CONCLUSION According to the clear benefits and the low risks of ECV attempt, all women with a breech presentation at term should be informed that ECV should be attempted to decrease breech presentation at birth and cesarean section.
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Affiliation(s)
- G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental, Les Oudairies, 85000 La Roche-sur-Yon, France.
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Coffman JC, Herndon BH, Thakkar M, Fiorini K. Anesthesia for Non-delivery Obstetric Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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What’s new in clinical obstetric anesthesia in 2015? Int J Obstet Anesth 2017; 32:54-63. [DOI: 10.1016/j.ijoa.2017.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/22/2017] [Accepted: 03/12/2017] [Indexed: 12/20/2022]
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Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation. Anesthesiology 2017; 127:625-632. [DOI: 10.1097/aln.0000000000001796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Background
Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose–response effect. We hypothesized that increasing the intrathecal bupivacaine dose would be associated with increased external cephalic version success.
Methods
We conducted a randomized, double-blind trial to assess the effect of four intrathecal bupivacaine doses (2.5, 5.0, 7.5, 10.0 mg) combined with fentanyl 15 μg on the success rate of external cephalic version for breech presentation. Secondary outcomes included mode of delivery, indication for cesarean delivery, and length of stay.
Results
A total of 240 subjects were enrolled, and 239 received the intervention. External cephalic version was successful in 123 (51.5%) of 239 patients. Compared with bupivacaine 2.5 mg, the odds (99% CI) for a successful version were 1.0 (0.4 to 2.6), 1.0 (0.4 to 2.7), and 0.9 (0.4 to 2.4) for bupivacaine 5.0, 7.5, and 10.0 mg, respectively (P = 0.99). There were no differences in the cesarean delivery rate (P = 0.76) or indication for cesarean delivery (P = 0.82). Time to discharge was increased 60 min (16 to 116 min) with bupivacaine 7.5 mg or higher as compared with 2.5 mg (P = 0.004).
Conclusions
A dose of intrathecal bupivacaine greater than 2.5 mg does not lead to an additional increase in external cephalic procedural success or a reduction in cesarean delivery.
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Ainsworth A, Sviggum H, Tolcher M, Weaver A, Holman M, Arendt K. Lessons learned from a single institution’s retrospective analysis of emergent cesarean delivery following external cephalic version with and without neuraxial anesthesia. Int J Obstet Anesth 2017; 31:57-62. [DOI: 10.1016/j.ijoa.2017.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/30/2022]
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Magro-Malosso ER, Mele M, Saccone G, Berghella V. Reply. Am J Obstet Gynecol 2016; 215:676. [PMID: 27423523 DOI: 10.1016/j.ajog.2016.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Elena Rita Magro-Malosso
- Department of Health Science, Division of Pediatrics, Obstetrics and Gynecology, Careggi Hospital University of Florence, Florence, Italy
| | - Michele Mele
- Department of Anesthesiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
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Magro-Malosso ER, Saccone G, Di Tommaso M, Mele M, Berghella V. Neuraxial analgesia to increase the success rate of external cephalic version: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol 2016; 215:276-86. [PMID: 27131581 DOI: 10.1016/j.ajog.2016.04.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND External cephalic version is a medical procedure in which the fetus is externally manipulated to assume the cephalic presentation. The use of neuraxial analgesia for facilitating the version has been evaluated in several randomized clinical trials, but its potential effects are still controversial. OBJECTIVE The objective of the study was to evaluate the effectiveness of neuraxial analgesia as an intervention to increase the success rate of external cephalic version. DATA SOURCES Searches were performed in electronic databases with the use of a combination of text words related to external cephalic version and neuraxial analgesia from the inception of each database to January 2016. STUDY ELIGIBILITY CRITERIA We included all randomized clinical trials of women, with a gestational age ≥36 weeks and breech or transverse fetal presentation, undergoing external cephalic version who were randomized to neuraxial analgesia, including spinal, epidural, or combined spinal-epidural techniques (ie, intervention group) or to a control group (either intravenous analgesia or no treatment). STUDY APPRAISAL AND SYNTHESIS METHODS The primary outcome was the successful external cephalic version. The summary measures were reported as relative risk or as mean differences with a 95% confidence interval. TABULATION, INTEGRATION, AND RESULTS Nine randomized clinical trials (934 women) were included in this review. Women who received neuraxial analgesia had a significantly higher incidence of successful external cephalic version (58.4% vs 43.1%; relative risk, 1.44, 95% confidence interval, 1.27-1.64), cephalic presentation in labor (55.1% vs 40.2%; relative risk, 1.37, 95% confidence interval, 1.08-1.73), and vaginal delivery (54.0% vs 44.6%; relative risk, 1.21, 95% confidence interval, 1.04-1.41) compared with those who did not. Women who were randomized to the intervention group also had a significantly lower incidence of cesarean delivery (46.0% vs 55.3%; relative risk, 0.83, 95% confidence interval, 0.71-0.97), maternal discomfort (1.2% vs 9.3%; relative risk, 0.12, 95% confidence interval, 0.02-0.99), and lower pain, assessed by the visual analog scale pain score (mean difference, -4.52 points, 95% confidence interval, -5.35 to 3.69) compared with the control group. The incidences of emergency cesarean delivery (1.6% vs 2.5%; relative risk, 0.63, 95% confidence interval, 0.24-1.70), transient bradycardia (11.8% vs 8.3%; relative risk, 1.42, 95% confidence interval, 0.72-2.80), nonreassuring fetal testing, excluding transient bradycardia, after external cephalic version (6.9% vs 7.4%; relative risk, 0.93, 95% confidence interval, 0.53-1.64), and abruption placentae (0.4% vs 0.4%; relative risk, 1.01, 95% confidence interval, 0.06-16.1) were similar. CONCLUSION Administration of neuraxial analgesia significantly increases the success rate of external cephalic version among women with malpresentation at term or late preterm, which then significantly increases the incidence of vaginal delivery.
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Weiniger CF, Sultan P, Dunn A, Carvalho B. Survey of external cephalic version for breech presentation and neuraxial blockade use. J Clin Anesth 2016; 34:616-22. [PMID: 27687460 DOI: 10.1016/j.jclinane.2016.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/26/2016] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Neuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV. SETTING AND DESIGN We surveyed Society for Obstetric Anesthesia and Perinatology members regarding ECV practice using a 15-item survey developed by 3 obstetric anesthesiologists and tested for face validity. The survey was e-mailed in January 2015 and again in February 2015 to the 1056 Society of Obstetric Anesthesiology and Perinatology members. We present descriptive statistics of responses. PARTICIPANTS Our survey response rate was 322 of 1056 (30.5%). MAIN RESULT Neuraxial blockade was used for ECV always by 18 (5.6%), often by 52 (16.1%), sometimes by 98 (30.4%), rarely by 78 (24.2%), and never by 46 (14.3%) of respondents. An anesthetic sensory block target was selected by 141 (43.8%) respondents, and analgesic by 102 (31.7%) respondents. Epidural drug doses ranged widely, including sufentanil 5-25 μg; lidocaine 1% or 2% 10-20 mL, bupivacaine 0.0625% to 0.5% 6-15 mL, and ropivacaine 0.2% 20 mL. Intrathecal bupivacaine was used by 182 (56.5%) respondents; the most frequent doses were 2.5 mg used by 24 (7.5%), 7.5 mg used by 35 (10.9%), and 12 mg used by 30 (9.3%). CONCLUSIONS Neuraxial blockade is not universally offered to facilitate ECV, and there is wide variability in neuraxial blockade techniques, in drugs and doses administered, and in the sensory blockade (anesthetic or analgesic) targeted. Future studies need to evaluate and remove barriers to allow for more widespread use of neuraxial blockade for pain relief and to optimize ECV success rates.
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Affiliation(s)
- Carolyn F Weiniger
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Pervez Sultan
- Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, UK.
| | - Ashley Dunn
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA.
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA.
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