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Anesthesia facilitation of external cephalic version: a meta-analysis.
Alison J Macarthur1, Sophie Gagnon, Luminita M Tureanu
1Department of Anesthesia, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5. alison.macarthur@uhn.on.ca
American Journal of Obstetrics and Gynecology
|October 28, 2004
Summary
Anesthesia improves the success rate of external cephalic version (ECV) for breech presentations. This meta-analysis found a 1.5 relative risk of success with anesthesia, with a number needed to treat of 7.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Perinatology
Background:
- External cephalic version (ECV) is a procedure to turn a breech fetus to a cephalic presentation before labor.
- Anesthesia use during ECV is debated, with limited evidence on its efficacy and safety.
Purpose of the Study:
- To systematically review the medical literature and determine if anesthesia facilitates the external cephalic version (ECV) maneuver for breech presentations.
- To analyze the impact of anesthesia on the immediate success rate of ECV attempts.
Main Methods:
- A meta-analytic review of randomized clinical trials comparing anesthesia with no anesthesia for ECV attempts.
- Literature search across medical databases for relevant studies meeting inclusion criteria.
Main Results:
- Four articles with a total of 480 women met the inclusion criteria.
- Anesthesia significantly increased the success rate of ECV attempts (119/238 with anesthesia vs. 82/242 without anesthesia).
- The relative risk for successful ECV with anesthesia was 1.5 (95% CI 1.12-1.98), with a number needed to treat of 7 (95% CI 4-14).
Conclusions:
- Anesthesia appears to facilitate external cephalic version (ECV) for breech presentations.
- Further research is necessary to evaluate the maternal and neonatal safety profiles of anesthesia administered during ECV maneuvers.