Central neuraxial blockade promotes external cephalic version success after a failed attempt

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Perinatal Medicine

Background:

• External cephalic version (ECV) is a procedure to turn a breech fetus to a cephalic presentation.
• ECV reduces cesarean delivery rates, fetal, and maternal morbidity.
• Limited data exist on the efficacy of central neuraxial blockade for ECV after previous failures.

Purpose of the Study:

• To evaluate the efficacy and safety of spinal and epidural anesthesia for external cephalic version (ECV) in patients with previously failed ECV attempts.
• To assess the success rates of ECV under neuraxial anesthesia in multiparous and nulliparous parturients.

Main Methods:

• Retrospective review of 77 external cephalic version (ECV) attempts performed between 1995 and 1999.
• Analysis included 15 patients who underwent ECV with spinal or epidural anesthesia after initial failed attempts.
• Standardized tocolytic and anesthetic regimens were utilized.

Main Results:

• Neuraxial anesthesia was associated with high ECV success rates: 100% in multiparous and 82% in nulliparous women.
• Overall ECV success rates were 83% with spinal and 89% with epidural anesthesia.
• Vaginal delivery occurred in 40% of spinal and 75% of epidural cases; one urgent cesarean delivery had good outcomes.

Conclusions:

• Central neuraxial anesthesia, specifically spinal and epidural techniques, demonstrates a significant success rate for external cephalic version (ECV) following prior failed attempts.
• These findings suggest that neuraxial anesthesia is a promising method to improve ECV success in challenging cases.